CAP, Outpatient
[Am J Respir Crit Care Med 2019;200: e45-67, NICE guideline]- Calculation of CRB-65, CURB-65 score, or Pneumonia Severity Index (PSI) is recommended to help determine severity, site of care, and mortality risk.
S. pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae
| Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin | 1g PO tid | |
| Penicillin/amoxicillin allergy | ||
| Doxycycline | 200mg PO once, then | |
| 100mg PO bid |
|
Alternative
| Therapy | Dose | Duration |
|---|---|---|
| Azithromycin | 500mg PO daily | 3 days |
| or | ||
| Clarithromycin | 500mg PO bid or | |
| XL 1g PO daily |
Moderate - based on clinical judgement and guided by CRB-65 score 1 or 2 or CURB-65 2 or PSI score III
Usual Pathogens
S. pneumoniae
H. influenzae
S. aureus
Moraxella catarrhalis
Enterobacterales
Mycoplasma pneumoniae
Legionella spp
Chlamydia pneumoniae
Consider SARS-CoV-2, and influenza during epidemic season.
| Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin | 1g PO tid | |
| or | ||
| Amoxicillin-clavulanate | 875mg PO bid | |
|
If CRB-65 score 1 and significant co-morbidity, or CRB-65 score 2, add:
|
||
| [Doxycycline | 200mg PO once, then | |
| 100mg PO bid | ||
| or | ||
| Azithromycin | 500mg PO daily | 3 days |
| or | ||
| Clarithromycin] | 500mg PO bid or | |
| XL 1g PO daily | ||
| Penicillin/amoxicillin allergy | ||
| Cefuroxime axetil | 500mg PO bid | 3-5 days |
|
If CRB-65 score 1 and significant co-morbidity, or CRB-65 score 2, add:
|
||
| [Doxycycline | 200mg PO once, then | 3-5 days |
| 100mg PO bid | ||
| or | ||
| Azithromycin | 500mg PO daily | |
| or | ||
| Clarithromycin] | 500mg PO bid | 3-5 days |
| Penicillin/amoxicillin & cefuroxime allergy | ||
| Levofloxacin | 750mg PO daily | 3-5 days |
- Expect clinical improvement/stability at 48-72 hours of appropriate therapy. If no improvement, or deterioration, consider non-infectious etiologies as well as the following infectious etiologies (depending on epidemiologic setting/risk factors):
- Methicillin-resistant S. aureus (MRSA)
- Viral pneumonia, including Influenza, SARS-CoV-2
- Mycobacterium tuberculosis
- Nocardia spp
- Actinomyces spp
- Chlamydophila psittaci
- Coxiella burnetti (Q fever)
- Francisella tularensis (tularemia)
- Bordetella pertussis (whooping cough)
- Endemic fungi (Histoplasma capsulatum, Coccidioides immitis, Cryptococcus neoformans, Blastomyces spp)
- Pneumocystis jirovecii