Pneumonia: Are we putting the CURB score into practice?

doi:10.1136/bmj.332.7551.1213-a

BMJ 2006;332:1213 (20 May), doi:10.1136/bmj.332.7551.1213-a

Letter

Pneumonia

Are we putting the CURB score into practice?

The first 150 words of the full text of this article appear below.

EDITOR—Hoare and Li suggest that patients with pneumoniashould receive antibiotics intravenously if they have a CURBscore of at least 3, or contraindications to oral treatment,which may include malabsorption, impaired consciousness, orrisk of aspiration.¹ They also assert that intravenous antibioticsshould be changed to oral treatment as soon as possible.

These two points are in accordance with current guidelines fromthe British Thoracic Society and are designed to limit the prescriptionof intravenous antibiotics when not indicated. This is becauseof their undesirable effect on microbial resistance, as wellas their side effect profile and greater cost.

We recently audited the treatment of pneumonia in our districtgeneral hospital and found that antibiotics were prescribedintravenously to 54% of patients (28 out of 52) with a CURBscore of 0 or 1. These patients do not qualify for intravenousantibiotics according to the current guidelines.

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D Owen, senior house officer (medicine)

david.owen@doctors.net.uk, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire AL7 4HQ

Tamara Shiner, senior house officer (medicine), Ramachandran Sivakumar, specialist registrar (care of elderly), Richard Dent, consultant (respiratory medicine)

Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire AL7 4HQ

Christopher Hilton, preregistration house officer (medicine)

Chelsea and Westminster Hospital, London SW10 9NH