Community-acquired pneumonia

Meet the patient

A 68-year-old smoker with diabetes arrives with three days of fever, rusty sputum, right-sided pleuritic pain, and worsening breathlessness. He is alert, respiratory rate 26, blood pressure 124 over 72, oxygen saturations 93 per cent on room air, and his urea is 8.4. The chest X-ray shows right lower-lobe consolidation. Urea above 7 mmol/L and age 65 or older give him CURB-65 of 2; NICE considers hospital-based care at score 2 or more, not automatic intensive care.[4][15]

The two questions that decide every CAP are the two the bedside answers in a minute: how sick is he? (CURB-65) and which drug, how fast? (the antibiotic ladder). Hold those two questions and everything below slots into place.[4][8]

References16Show ledgerHide ledger

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13. [13]Barbash IJ, Gellad WF, Handley NR, et al. Treatment patterns and clinical outcomes after the introduction of the Medicare sepsis performance measure (SEP-1). Ann Intern Med, 2021.PMID 33872042
14. [14]Rahman NM, Maskell NA, West A, et al. Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med, 2011.PMID 21830966
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