6. Respiratory tract infection

CURB-65 Score
Severity assessment score for community acquired pneumonia
Any of: (score 1 for each feature present)
Confusion
Urea >7mmol/l
Respiratory rate > 30/min
Blood pressure SBP < 90mmHg +/or DBP< 60mmHg
Age > 65 years

Use clinical judgement if patient is clearly ill and give first dose of antibiotics as soon as possible

Infection	IV treatment	Oral treatment	Duration
Community acquired pneumonia Refer to CURB-65 to assess severity	CURB-65 score <3 Amoxicillin 500mg tds IV plus clarithromycin 500mg* Review at 24 hours Penicillin allergy Clarithromycin 500mg bd* CURB-65 score 3 or more Co-Amoxiclav 1.2g tds* plus clarithromycin 500mg bd*. Review at 48 hours Penicillin allergy Levofloxacin 500mg bd* (If epileptic consult micro)	CURB-65 score <3 Amoxicillin 500mg-1g tds plus clarithromycin 500mg bd . Penicillin allergy Clarithromycin 500mg bd CURB-65 score 3 or more Co-amoxiclav 625mg tds plus clarithromycin 500mg bd. Penicillin allergy Levofloxacin 500mg bd	7 days       10 days
Aspiration pneumonia	Co-amoxiclav 1.2g tds* Penicillin allergy Levofloxacin 500mg bd* plus metronidazole 500mg tds (If epileptic consult micro)	Co-amoxiclav 625mg tds Penicillin allergy Levofloxacin 500mg bd plus metronidazole 400mg tds	7-10 days
Hospital acquired pneumonia > 5 days in hospital	Timentin 3.2g qds* Penicillin allergy Levofloxacin 500mg bd* (If epileptic consult micro) Review at 48 hours	Treat according to cultures	7 days
Exacerbation of COPD if 2 or more of increased Breathlessness Sputum colour/ purulence Sputum volume	Only if severe / oral route compromised Co-amoxiclav 600mg - 1.2g tds*	Doxycycline 200mg stat then 100mg daily	7 days

Tuberculosis (TB)
Refer to specialist consultant physician experienced in treating TB (Prof Denning)

*For patients with renal impairment refer to section 23 for dosage adjustments