Pneumonia

Editor—Hoare and Li suggest that patients with pneumonia should receive antibiotics intravenously if they have a CURB score of at least 3, or contraindications to oral treatment, which may include malabsorption, impaired consciousness, or risk of aspiration.¹ They also assert that intravenous antibiotics should be changed to oral treatment as soon as possible.

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

We recently audited the treatment of pneumonia in our district general hospital and found that antibiotics were prescribed intravenously to 54% of patients (28 out of 52) with a CURB score of 0 or 1. These patients do not qualify for intravenous antibiotics according to the current guidelines.

We surmise that this overprescription of intravenous antibiotics is partly because junior doctors, who are responsible for admitting such patients, are not officially taught the CURB score, which rarely features in either finals or membership examinations for the Royal College of Physicians. In only 1.6% of cases (2 out of 126) was the CURB score documented on the admission clerking.

Of all the well validated scoring systems used in clinical practice, the CURB score is probably the most memorable and simple to apply. Hence its inclusion in the guidelines for treating community acquired pneumonia. Despite this, it is not being put into practice. These findings illustrate the wider problem of transferring knowledge produced from academic research to the clinical shop floor.