quick reference
CURB-65 Score for Pneumonia Severity
PSI/PORT Score: Pneumonia Severity Index for CAP
2025 ATS CAP Guidelines
Diagnosis and Management of Community-acquired Pneumonia
2019 IDSA/ATS Clinical Pathway
CAP Clinical Pathway
Microbiology
Most Common Bugs:
- S. pneumoniae
- Haemophilus influenzae
- Atypicals
Be Aware of:
- MRSA
- Pseudomonas
- Viruses
clinical features
Respiratory Symptoms
- New or increased cough
- New or increased sputum production
- Dyspnea
- Pleuritic chest pain
Other Signs or Findings - Abnormal lung sounds (rhonchi or rales)
- Fever (≥100.4 °F)
- Leukocytosis or unexplained bandemia (above normal limits for laboratory)
- Hypoxia (< 90%)
Severe CAP
One major criterion OR three or more minor criteria
Major Criteria
- Septic shock with need for vasopressors
- Respiratory failure requiring Mechanical Ventilation
Minor Criteria
- Respiratory rate ≥ 30 breaths/min
- PaO2/FIO2 ratio ≤ 250*
- Multilobar (i.e., ≥ 2) infiltrates
- Confusion/disorientation
- Uremia (blood urea nitrogen level ≥ 20 mg/dl)
- Leukopenia (white blood cell count < 4,000 cells/µl)†
- Thrombocytopenia (platelet count < 100,000/µl)
- Hypothermia (core temperature < 36C)
- Hypotension requiring aggressive fluid resuscitation
workup
Non-Severe CAP
- Chest X-ray
- CBC
- Rapid COVID/Flu
- *MRSA Nasal Swab
- IF: hospitalization and parenteral antibiotics in the last 90 days OR anti-MRSA coverage is initiated
Severe CAP
- Chest X-ray +/- Chest CT
- CBC
- Rapid COVID/Flu (if positive, +/- procalcitonin)
- *MRSA Nasal Swab
- IF: hospitalization and parenteral antibiotics in the last 90 days OR anti-MRSA coverage is initiated
- Sputum culture
- Legionella + Pneumococcus Urine Antigen test
diagnosis
- Newly recognized pulmonary infiltrate(s) on chest imaging
- AND at least one respiratory symptom
- New or increased cough
- New or increased sputum production
- Dyspnea
- Pleuritic chest pain
- AND at least one other symptom/sign or finding
- Abnormal lung sounds (rhonchi or rales)
- Fever (≥100.4 °F)
- Leukocytosis or unexplained bandemia (above normal limits for laboratory)
- Hypoxia (< 90%)
treatment
Non-severe CAP
Outpatient Treatment (without hypoxia and CURB-65 ≤ 1)
≤5 days of antibiotic therapy (2025 ATS Guidelines)
No Comorbidities:
1. Doxycycline or Amoxicillin Monotherapy, Moxifloxacin if allergies
Comorbidities:
2. Beta-lactam + Atypical Coverage
- Augmentin PO + Macrolide/Tetracycline
3. Fluoroquinolone Monotherapy
- Moxifloxacin
Inpatient Treatment
>5 days of antibiotic therapy (2025 ATS Guidelines)
1. Ceftriaxone + Azithromycin OR Moxifloxacin (if allergies)
Pseudomonas Risk Factors (hospitalized for 3 or more days AND received IV ABX in past 90 days OR history of isolation of Pseudomonas from respiratory culture in the past year)
2. Cefepime or Pip/Tazo PLUS Azithromycin
Severe CAP
- Steroids: 200mg Hydrocortisone QD for 5-7 days
algorithm
