How to assess community-acquired pneumonia severity and choose treatment in prim

Assessment of severity: In primary care, the severity of community-acquired pneumonia (CAP) should be assessed using the CRB65 scoring system, which assigns 1 point each for confusion, respiratory rate ≥30 breaths/min, low blood pressure (systolic <90 mmHg or diastolic ≤60 mmHg), and age ≥65 years.

Patients are stratified by mortality risk: 0 points indicate low risk (<1% mortality), 1-2 points intermediate risk (1-10%), and 3-4 points high risk (>10%).

Clinical judgement should be used alongside the CRB65 score, considering factors such as comorbidities or pregnancy.

Management decisions based on CRB65: Consider hospital assessment for patients with a CRB65 score of 2 or more.

For those with a score of 1, discuss care options and make a shared decision, which may include supported home-based care.

Patients with a score of 0 can generally be managed with home-based care.

Treatment selection: Antibiotic prescribing should follow NICE antimicrobial guidelines for community-acquired pneumonia.

Microbiological tests are not routinely required in low-severity cases.

Point-of-care C-reactive protein (CRP) testing may support antibiotic decisions if clinical uncertainty exists: immediate antibiotics if CRP >100 mg/L, consider back-up prescription if CRP 20-100 mg/L, and no antibiotics if CRP <20 mg/L.

Patients should be advised to seek further medical advice if symptoms worsen or do not improve as expected.