Respiratory14 UKMLA questions
Pneumonia — UKMLA Revision Notes
Pneumonia is an acute infection of the lung parenchyma causing consolidation. Community-acquired pneumonia (CAP) is most commonly caused by Streptococcus pneumoniae. Severity is assessed using the CURB-65 score to guide inpatient vs outpatient management.
Key Facts
- Most common causative organism: Streptococcus pneumoniae
- CURB-65 score: Confusion, Urea >7, RR ≥30, BP <90/60, age ≥65
- CURB-65 0–1: outpatient treatment; ≥3: consider ICU
- Atypical organisms (Mycoplasma, Legionella, Chlamydophila) require macrolide cover
- Legionella: associated with hyponatraemia, high urinary antigen sensitivity
Investigations
- CXR: consolidation (lobar or patchy), pleural effusion
- FBC: raised WBC (neutrophilia in bacterial, lymphocytosis in viral/atypical)
- CRP, U&E, LFTs
- Blood cultures: before antibiotics in moderate/severe CAP
- Sputum culture, urinary Legionella and pneumococcal antigens
Management
- Mild CAP (CURB-65 0–1): amoxicillin 500mg TDS for 5 days (NICE NG138)
- Moderate CAP (CURB-65 2): amoxicillin + clarithromycin or doxycycline
- Severe CAP (CURB-65 3–5): co-amoxiclav + clarithromycin IV
- Oxygen: target SpO₂ 94–98% (88–92% in COPD)
- Review at 48 hours; switch to oral when clinically improving
NICE Guideline: NICE NG138 — Pneumonia (community-acquired): antimicrobial prescribing (2019)
Related UKMLA Conditions
COPDPleural EffusionSepsisLung Abscess