Initial Empirical Treatment Regimens for Community-Acquired Pneumonia in Adults (Source: Adapted from British Thoracic Society Guidelines)
| Severity | Site | Preferred treatment | Penicillin allergy |
|---|---|---|---|
| Low (CURB-65 = 0–1, mortality <3%) | Home | Amoxicillin 500 mg TDS orally for 5 days. | Doxycycline 200 mg loading dose then 100 mg orally or clarithromycin 500 mg bd orally for 5 days. |
| Low severity (CURB-65 = 0–1, mortality <3%) but admission indicated for reasons other than pneumonia severity (e.g. social reasons) | Hospital | Amoxicillin 500 mg tds orally. If oral administration not possible: amoxicillin 500 mg tds IV for 5 days. | Doxycycline 200 mg loading dose then 100 mg od orally or clarithromycin 500 mg bd orally for 5 days. |
| Moderate severity (CURB-65 = 2, 9% mortality) | Hospital | Amoxicillin 500 mg –1.0g tds orally plus clarithromycin 500 mg bd orally. If oral administration not possible: amoxicillin 500 mg tds IV plus clarithromycin 500 mg bd IV. | Doxycycline 200 mg loading dose then 100 mg orally or levofloxacin 500 mg od orally or moxifloxacin 400 mg od orally. |
| High severity (CURB-65 = 3–5, 15–40% mortality) | Hospital | Co-amoxiclav 1.2g tds IV plus clarithromycin 500 mg bd IV. | Vancomycin 1.g bd IV plus clarithromycin 500.mg bd IV or Lower case 500 mg bd IV or Cefuroxime 1.5g tds IV or cefotaxime 1g tds IV or ceftriaxone 2g od IV, plus clarithromycin 500 mg bd IV |