A 70-year-old man presents with community-acquired pneumonia. He is alert and oriented, respiratory rate 31/min, blood pressure 106/64 mm Hg, temperature 38.4 degrees C, and serum urea is 8.1 mmol/L. What is the most appropriate initial disposition?

• A Hospital admission for parenteral antibiotics ✓
• B Oral antibiotics as an outpatient with review in 48 hours
• C Immediate endotracheal intubation and ventilation
• D Discharge home with nebulised salbutamol

Explanation

CURB-65 gives one point each for Confusion, Urea above 7 mmol/L, Respiratory rate of 30 or more, low Blood pressure (systolic below 90 or diastolic 60 or less), and age 65 or more. This patient scores 3 (urea, respiratory rate, age), which places him in the severe category with roughly 15% 30-day mortality, mandating hospital admission and consideration of critical care review. B score of 0 or 1 would suit outpatient management, which makes option B the tempting wrong answer.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.