16 responses to “Community acquired pneumonia”

  1. Back to Penicillin which is a great.

  2. good practice points

  3. I like the idea of using Amoxil and also using Doxy

  4. I like the simplicity of the staging of severity, when to admit, when to admit to ICU etc.

  5. I agree that assessing for comorbidities is key to clinical outcomes

  6. Concise, easy to follow recommendations. Nicely presented and thought – out.

  7. Good to know that staying with Amoxil for lower risk patients is still valid. Concise risk scoring to make triaging a little easier.

  8. consistent with current practice

  9. Interesting that we’re back to penicillin group again.

  10. Interesting that we’re back to amoxicillin

  11. The CURB score is a bit vague in terms of diagnosis: What about proper clinical examination and finding: Lung signs > then WBC / CRP count / blood culture prior to treatment /CXR
    Many other conditions can give a similar ‘CURB’ score and I can not trust that as an only diagnostic guideline.
    Treatment choice:
    Amoxycillin + Clavulanic acid 0.75-1,5g O/IV q4-6h
    Amikacin 15mg/kg IV q12h
    Gentamycin 5mg/kg IV q 8h00
    Vancomycin 2g IV q 6-12h00

  12. With respect to Dr.VG Lotfie-Eaton’s concerns, I would like to reply as follows:
    1- CURB65 itself is a general manifestation and classifcation of systemic inflamatory response syndrome which I agree applies to various clinical scenarios, however it will be only more meaningful once the diagnosis of pneumonia is established by clinician and then it can guide the modality of therapy depends on the scores and will help with timely management plan in the right place i,e.. wards versus intensive care unit vice versa.
    2- Having said that, it only serves as a guide and not an absolute measure for patient’s management purposes. The final disposition for ill patient only will be detemined by clinician and nothing to my estimate could ever replace it!

    But very good point for discussion though!



  13. like the CURB65, practical for hospital-based medicine..

  14. Would a history of not having the flu shots or the pneumovax shots add an extra point when assessing risk?

  15. In reply to Dr. J. Burke’s comment, the answer is yes, and it has two important application with it,
    1- if no Vaccines and the syndrome prodromed by Coryza, sever Myalgia and other specific can bring a strong argue in favor of Viral pneumonia with influenza strain, so early treatment with Oseltamivir would be advocated and important in Survival
    2- At times secondary bacterial Pneumonia can be a consequence of a primary viral pneumoniae especially influenza pneumonia, so it can direct the antibiotics therapy in favor of antibacterials and more specifically, Staphylococcus and Streptococcus pneumonia.



  16. Good to know Penicilline is back as fist choice

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