BTS guidelines for CAP table
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"community-acquired pneumonia" AND guideline
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British Thoracic Society community acquired pneumonia guideline CURB-65 antibiotic treatment adults
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https://www.brit-thoracic.org.uk/document-library/guidelines…
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BTS guideline summary for adult community-acquired pneumonia (CAP)
The BTS adult CAP guideline is the 2009 guideline. It remains useful for severity assessment and initial antibiotic choices, but for antibiotic duration and some review/testing points, BTS advises following the newer NICE pneumonia guidance where they differ. See the official BTS quick-reference guide and the BTS-NICE comparison update.
| Severity | CURB-65 | Approx. mortality | Usual site of care | BTS initial empirical antibiotic regimen |
|---|---|---|---|---|
| Low | 0-1 | <3% | Home, unless social factors, hypoxia, unstable comorbidity, or poor oral intake necessitate admission | Amoxicillin 500 mg PO three times daily. Alternatives: doxycycline 200 mg loading dose, then 100 mg once daily; or clarithromycin 500 mg PO twice daily. |
| Low, admitted for non-severity reasons | 0-1 | <3% | Hospital | Oral amoxicillin as above. If oral therapy not possible: amoxicillin 500 mg IV three times daily. |
| Moderate | 2 | ~9% | Hospital | Amoxicillin 500 mg to 1 g PO three times daily + clarithromycin 500 mg PO twice daily. If oral therapy is unsuitable: amoxicillin 500 mg IV three times daily or benzylpenicillin 1.2 g IV four times daily + clarithromycin 500 mg IV twice daily. |
| High / severe | 3-5 | 15%-40% | Hospital, with urgent senior and critical-care review | Give antibiotics as soon as possible. Co-amoxiclav 1.2 g IV three times daily + clarithromycin 500 mg IV twice daily. An alternative is benzylpenicillin 1.2 g IV four times daily plus levofloxacin 500 mg IV twice daily. Consider Legionella-active therapy when clinically indicated. |
CURB-65 score
Give 1 point for each feature:
| Letter | Criterion |
|---|---|
| C | New confusion |
| U | Urea >7 mmol/L |
| R | Respiratory rate ≥30/min |
| B | Blood pressure: systolic <90 mmHg or diastolic ≤60 mmHg |
| 65 | Age ≥65 years |
Community assessment: CRB-65
Use CRB-65 when urea is unavailable.
| CRB-65 score | BTS action |
|---|---|
| 0 | Usually suitable for home treatment, if clinical and social circumstances permit |
| 1-2 | Consider hospital referral |
| 3-4 | Urgent hospital admission |
Key BTS management points
| Domain | Recommendation |
|---|---|
| Diagnosis | Confirm with chest radiograph where possible, especially in hospital. |
| Timing | Aim to establish diagnosis and start management, including antibiotics, within 4 hours of hospital presentation. |
| Microbiology | Blood cultures, sputum culture, pneumococcal/Legionella urinary antigen testing, and other tests are mainly indicated in moderate or high-severity disease, ICU admission, treatment failure, or specific epidemiological risk. |
| Critical care | Urgent senior review for severe CAP; actively consider critical-care involvement, particularly with CURB-65 of 4-5 or physiological deterioration. |
| Supportive care | Assess oxygenation, give oxygen where needed, correct fluid/electrolyte abnormalities, provide thromboprophylaxis if admitted unless contraindicated, and monitor for sepsis/respiratory failure. |
| Follow-up radiograph | Consider a chest radiograph at about 6 weeks for persistent symptoms/signs or increased malignancy risk, especially smokers and people aged over 50. |
Important update: the BTS antibiotic-dose table above is from the 2009 UK guidance. Current prescribing should follow local antimicrobial policy and current NICE guidance, especially for treatment duration, allergy alternatives, pregnancy, renal impairment, QT-risk drugs, and suspected aspiration or Legionella. The 2009 BTS severity categories are still: low CURB-65 0-1, moderate 2, and high 3-5.
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