The CURB-65 score, also known as the CURB-65 criteria, is a validated clinical prediction tool used to assess the severity of pneumonia and predict mortality risk in patients with community-acquired pneumonia (CAP).
This score is an acronym for Confusion, Urea, Respiratory Rate, Blood pressure, and Age. It is a widely used scoring system, simple to administer, and can be applied quickly in clinical settings to aid in managing pneumonia.
The CURB-65 Criteria
The scoring system uses five clinical variables that have been shown to be independent predictors of mortality in patients with CAP. The CURB-65 criteria are:
- Confusion of new onset (AMTS <8)
- Urea >7 mmol/l
- Respiratory rate >30 per minute
- Blood pressure <90 mmHg systolic or <60 mmHg diastolic
- Age >65 years
Association with mortality risk
The scores for each of the five variables are summed to give a total score between 0 and 5. The higher the score, the greater the mortality risk in patients with CAP.
The following table shows the risk of mortality associated with each CURB-65 score:
| CURB-65 Score | Risk of Mortality |
|---|---|
| 0 | Less than 1% |
| 1 | 1-3% |
| 2 | 4-14% |
| 3 | 15-40% |
| 4-5 | More than 40% |
Using CURB-65 to guide management
A score of 0-1 is considered low-risk, and treatment as an outpatient is recommended. A score of 2 is considered intermediate risk, and either treatment as an inpatient or on an ambulatory care pathway is recommended. A score of 3-5 is considered high risk and will require hospitalisation and potentially critical care involvement.
Choice of antibiotic
The following table outlines the current NICE guideline recommendations for the choice of antibiotic in adults depending upon the CURB-65 score:
| Severity | Antibiotic choice |
|---|---|
| First-choice oral antibiotic if low severity (score 0-1) | Amoxicillin: 500mg three times a day |
| Alternative oral antibiotics if low severity (score 0-1), for penicillin allergy or if amoxicillin unsuitable (for example, if atypical pathogens suspected) | Doxycycline: 200 mg on first day, then 100 mg once a day for 4 days (5 day course in total) Clarithromycin: 500 mg twice a day for 5 days Erythromycin (in pregnancy): 500 mg four times a day for 5 days |
| First-choice oral antibiotics if moderate severity (score 2) | Amoxicillin: 500 mg three times a day for 5 days With (if atypical pathogens suspected) Clarithromycin: 500 mg twice a day for 5 days or Erythromycin (in pregnancy): 500 mg four times a day for 5 days |
| Alternative oral antibiotics if moderate severity, for penicillin allergy (guided by microbiological results when available) | Doxycycline: 200 mg on first day, then 100 mg once a day for 4 days (5 day course in total) Clarithromycin: 500 mg twice a day for 5 days |
| First-choice antibiotics if high severity (score 3-5) | Co amoxiclav: 500/125 mg three times a day orally or 1.2 g three times a day intravenously for 5 days With Clarithromycin: 500 mg twice a day orally or intravenously for 5 days or Erythromycin (in pregnancy): 500 mg four times a day orally for 5 days |
| Alternative antibiotic if high severity (score 3-5) for penicillin allergy | Levofloxacin (consider safety issues): 500 mg twice a day orally or intravenously for 5 days |
References:
CURB-65 Score for Pneumonia Severity
Pneumonia (community-acquired): antimicrobial prescribing
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Thank you to the joint editorial team of www.mrcemexamprep.net for this article.
