Management of Pneumonia
The CRB659 score is a clinical prediction rule that grades the severity of the community acquired pneumonia.
CRB65 score
One point is awarded for each of the following features:
• Confusion - recent
• Respiratory rate 30 breaths/min or greater
• Blood pressure - systolic of 90 mmHg or less or a diastolic of 60 mmHg or less
• 65 years of age or older
The table below shows CRB65 score is interpreted:
| Patient Score | Risk of Death | Do they require hospital referral? |
| 0 | low risk of death | Do not require hospitilisation for clinical reasons |
| 1-2 | increased risk of death, especially score of 2 | Hospital referral and assessment should be considered |
| 3+ | high risk of death | Requires urgent hospital admission |
General advice for patients with suspected pneumonia and a low CRB65 risk, is to rest, drink plenty of fluids and not to smoke. Using simple analgesia such as paracetamol6 to relieve chest pains.
Bacterial pneumococcal disease may be treated with antibiotics. Antibiotic choice and duration is dependent on the CRB65 risk.
After starting treatment symptoms should steadily improve – rate of improvement will vary dependant on severity of the pneumonia but patients should be advised5:
- 1 week: fever should have resolved
- 4 weeks: chest pain and sputum production should have substantially reduced
- 6 weeks: cough and breathlessness should have substantially reduced
- 3 months: most symptoms should have resolved but fatigue may still be present
- 6 months: most people will feel back to normal
Patients/Carers should be advised to seek advice if symptoms don’t improve or worsen after 3 days of treatment.