Bill
70, Male
The patient continued treatment with antibiotics as an outpatient as his CURB-65 score was 1 . The blood test results showed a normal serum urea concentration. During the 7 days of treatment the patient's fever abated and he felt somewhat better.
Advise the person to stop smoking (consider smoking cessation) and reduce alcohol consumption!
The most prevalent causative organism in bacterial pneumonia is pneumococcus regardless of the host. Empiric therapy must be selected with this organism in mind.
While many pneumonias are actually viral in nature, typical practice is to provide a course of antibiotics given the pneumonia may be bacterial.
Disposition (inpatient vs. outpatient) often dictates further care and management -- including lab testing, blood cultures, etc.
Management
The CURB-65 scores range from 0 to 5. Assign points as in the table based on confusion status, urea level, respiratory rate, blood pressure, and age. Clinical management decisions can be made based on the score, as described in the validation study below:
| Score | Risk | Disposition |
| 0 or 1 | 1.5% mortality | Outpatient care |
| 2 | 9.2% mortality | Inpatient vs. observation admission |
| ≥ 3 | 22% mortality | Inpatient admission with consideration for ICU admission with score of 4 or 5 |
Critical Actions
For patients scoring high on CURB-65, it would be prudent to ensure initial triage has not missed the presence of sepsis. Evaluation of SIRS criteria would be beneficial.