Empirical therapy guided by CURB-65; tailor to local antibiogram.
Regimens
Mild (CURB-65 0–1)
Amoxicillin 500 mg PO TDS × 5 d
If penicillin allergy: doxycycline 200 mg loading then 100 mg OD.
Moderate (CURB-65 2)
Amoxicillin 1 g PO TDS + clarithromycin 500 mg BD × 5–7 d
Severe (CURB-65 ≥3)
Co-amoxiclav 1.2 g IV TDS + clarithromycin 500 mg IV BD
Monitoring
- • CRP, WCC, temperature trend
- • Renal function (dose adjust)
- • Repeat CXR at 6 weeks if any abnormality
Common prescribing errors
- ⚠ Using macrolide alone for severe CAP
- ⚠ Not de-escalating once cultures back
- ⚠ Forgetting QT check with macrolide + QT-prolonging drugs
