Fever, productive cough, pleuritic pain, infiltrate on CXR
ABCDE O₂, IV access, fluids; antibiotics within 1 h if septic; lactate/cultures; severity score.
Calculators: curb news2
Order: CXR + blood cultures; severity by CURB-65 (PaO₂ <60 → ICU)
Inpatient: Ceftriaxone 1–2 g IV + Azithromycin (or levofloxacin) → step down to oral when improving
Outpatient: amoxicillin / doxycycline / azithromycin
ICU / risk factors → add vancomycin (MRSA) + antipseudomonal
Decision tree CURB-65 score?
0–1 Outpatient oral antibiotics
3–5 Severe — IV antibiotics, consider ICU (esp. 4–5)
Order set CXR CURB-65 Blood + sputum cultures FBC, U&E, CRP Antibiotics per severity O₂ Criteria Admit CURB-65 ≥2 or hypoxia
ICU CURB-65 4–5, septic shock, respiratory failure
Intubate Refractory hypoxaemia / exhaustion
Vasopressors Septic shock
Discharge Afebrile, SpO₂ stable on air, oral antibiotics tolerated, ≤1 CURB point
Clinical detail — differentials, red flags, pitfalls, disposition Red flags Sepsis/shock Hypoxia Multilobar Differentials Heart failure PE TB Malignancy Common mistakes Wrong severity triage Missing atypical/aspiration/TB Disposition & follow-up CURB-65-guided site of care; review at 48–72 h.
Discharge package Medications Complete antibiotic course
Follow-up CXR at 6 wk (exclude malignancy) if indicated
Vaccination Influenza + pneumococcal
Lifestyle Smoking cessation
Warning symptoms Persistent fever, breathlessness, haemoptysis
💊 Treatment detail — doses & preparation Amoxicillin CAP antibiotic
Dose 1 g PO TDS ×5 d (CURB-65 0–1 outpatient)
Preparation 500 mg capsules
Monitor Penicillin allergy → doxycycline/clarithromycin
Doxycycline tetracycline
Dose 100 mg BD (urethritis ×7 d, atypical CAP, tick-borne)
Preparation 100 mg capsules with full glass of water, stay upright 30 min
Monitor Photosensitivity, oesophagitis; avoid in pregnancy/children <8
Ceftriaxone 3rd-gen cephalosporin
Dose 2 g IV OD (meningitis 2 g q12h); gonorrhoea 500 mg–1 g IM once
Preparation IV: 2 g in 50–100 mL NS over 30 min; IM: reconstitute with lidocaine 1%
Monitor Biliary sludging; avoid with calcium-containing IV fluids in same line
Azithromycin macrolide
Dose CAP: 500 mg OD ×3–5 d; chlamydia 1 g once; dysentery 500 mg OD ×3 d
Preparation PO tablets/suspension; IV 500 mg in 250 mL over 1 h if NBM
Monitor QT prolongation; resistance rising in gonorrhoea (not monotherapy)
📖 IDSA-ATS / BTS CAP Reviewed July 2026