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CAP: Severity & empirical treatment

Src: BTS 2004 Update




empirical PO

empirical IV

- 0=0.7% Home* 1=AmoxPO
Confus.** 1=3.2% ?Home*
Urea>7 2=13% ?SSW 1=AmoxPO +Claribd
[2=LevoflPO | MoxiflPO]
RR≥30 3=17% Hosp
[from IV:
1={CoamoxIV | CefuroxIV | CefotaxIV | CeftriaxIV}+ClariIV
65≥age 5=57%

Amox=PO/IV0.5-1tds; AmpiIV=0.5qds; B-PenIV=1.2qds; Coamox=PO0.625/IV1.2tds
ClariPO=0.5bd; Levo=PO/IV0.5bd; MoxiflPO=0.4od
CefuroxIV=1.5tds; CefotaxIV=1tds; CeftriaxIV=2od;

*Discharge: Instability: T°>37.8°C; NBM/confus**; HR>100; RR>24; SBP<90; SO2<90%
**confusion: MTS<=8 or new disorientation in person/place/time

CAP - instability criteria

  • if {0 vs 2} of {Temp > 37.8 C | HR > 100 bpm | SO2 < 90% | Inability to take oral medication | Abnormal mental status} on discharge: {11 vs 46}% readmitted within 30d or died
  • Recommendations (2004): No more than one instability criterion (unless usual baseline) on discharge
    • T>37.8C
    • HR>100/min
    • RR>24/min
    • SBP<90mmHg
    • SO2<90%
    • Inability to take oral medication
    • Abnormal mental status

British Lung Foundation

Brit Thor Soc Guidelines

Pleural effusion:

Transudate vs Exudate:
if Prot<25g/L then Transudate
else if Prot>35g/L then Exudate
else if  ( Prot>50% S-Prot || LDH>60% S-LDH || LDH>2/3*ULN(S-LDH) ) then Exudate # Light's criteria
Parapneumonic effusion:
simple parapneumonic effusion: pH>7.2 AND LDH<1000 AND Glu>2.2 AND clear fluid AND Gram stain & culture negative,
else complicated effusion -> needs chest drain


EPAP: 4-5cm
IPAP: 10-12->16-20cm (as tolerated)
SO2: aim 88-92%


Indication: pO2<7.3[<8.0 if cor pulmonale or 2ry polycythaemia] on air x 2 occasions when stable
Aim: pO2>8, use for >16h per day: icrs life expectancy

Hypoxaemic respiratory failure

  • paO2 / FiO2<200mmHg=27kPa;

Spirometry reference values


MRC Dyspnoea Scale (1959)

Grade: Degree of breathlessness related to activities
1: Not troubled by breathlessness except on strenuous exercise
2: Short of breath when hurrying or walking up a slight hill
3: Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
4: Stops for breath after walking about 100m or after a few minutes on level ground
5: Too breathless to leave the house, or breathless when dressing or undressing
Adapted from Fletcher CM, Elmes PC, Fairbairn MB et al. (1959) The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. British Medical Journal 2:257–66.

Subpages (1): Asthma