- Confirm a clinical/radiographic diagnosis of community-acquired pneumonia in an immunocompetent adult, then enter the patient's vital signs (respiratory rate, pulse rate, systolic and diastolic BP, temperature). Each is auto-checked against the CPG thresholds.
- Tick the clinical features present — acute altered mental state, suspected aspiration, and any unstable / decompensated co-morbid condition.
- Tick the high-risk features (severe sepsis or septic shock, need for mechanical ventilation) and any MDRO risk factors to refine the empiric regimen.
- The tool returns the risk class, the recommended site of care, the criteria that drove it, and the guideline's empiric antibiotic regimen for that tier.
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When to Use
Use this tool to stratify adult community-acquired pneumonia by severity and choose the site of care and empiric antibiotics, following the 2020 Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of CAP in Immunocompetent Adults (PSMID, in collaboration with PCCP, PCP, PAFP and partner societies). Risk class is assigned by the most severe category any single criterion reaches.
Appropriate population
Immunocompetent adults (≥ 19 years) with a clinical and/or radiographic diagnosis of community-acquired pneumonia, evaluated at first contact (clinic, emergency department, or admission). Helps decide outpatient vs ward vs ICU care and the empiric antibiotic class.
When NOT to use it
Not validated for and not intended for: hospital-acquired / ventilator-associated pneumonia, severely immunocompromised hosts (e.g., neutropenia, advanced HIV, transplant on heavy immunosuppression), children, or pneumonia in pregnancy where obstetric factors dominate. These groups follow separate pathways. Risk stratification supports but never overrides bedside judgement.
Pearls & Pitfalls
One criterion is enough to escalate
The class is set by the worst single feature, not a tally. A fully alert patient whose only abnormality is a respiratory rate of 32/min is already moderate-risk and warrants admission. Likewise, septic shock or a need for mechanical ventilation places the patient in the high-risk (ICU) tier regardless of the other vitals.
Stable vs unstable co-morbids are different things
A stable co-morbid condition keeps the patient in the low-risk tier but shifts empiric therapy from the "no co-morbidity" regimen (Recommendation 7) to the "with stable co-morbidity" regimen (Recommendation 8). It is the unstable / decompensated co-morbid (uncontrolled DM, CHF II–IV, decompensated COPD or liver disease, renal failure on dialysis, etc.) that pushes the patient into moderate-risk.
Pitfalls
(1) Do not give routine anaerobic coverage for suspected aspiration unless lung abscess or empyema is suspected (Recommendation 11). (2) MDRO modifiers apply to moderate-to-high-risk CAP with a documented risk factor — they are not for every admitted patient. (3) This guideline is for immunocompetent adults; it does not localise antibiotic choice to your institution's antibiogram. (4) Temperature is abnormal at ≤ 36 °C as well as ≥ 40 °C — hypothermia counts.
Why Use It
CAP remains the leading infectious cause of death among Filipino adults. The Philippine CPG exists because importing foreign severity scores wholesale (PSI, CURB-65) does not reflect local pathogen prevalence, the rising rate of multidrug-resistant organisms among respiratory isolates, or the realities of where care is delivered across primary-to-tertiary settings. The 2020 update localises empiric therapy, embeds antimicrobial stewardship, and ties a simple three-tier severity scheme directly to the site of care and the starting antibiotic — so the decisions that most affect outcome (where to treat, what to start, and when to broaden for MDROs) are made consistently at first contact.
Philippine CAP Risk Stratification & Empiric Therapy
Enter the vital signs and tick the features present. The risk class, site of care, the criteria that drove the result, and the guideline's empiric antibiotic regimen update automatically.
Clinical & High-Risk Features (check if present)
MDRO Risk Factors (optional — refine empiric regimen)
⚕ Risk thresholds and empiric regimens per the 2020 Philippine CAP CPG (PSMID/PCCP/PCP). Localise antibiotic choice to your institution's antibiogram and the patient's allergies, renal/hepatic function, and weight. For licensed clinicians; does not replace individualized assessment.
Next Steps
Use the risk class to set disposition, diagnostics, and empiric therapy.
- Low-risk → outpatient. Gram stain/culture not required. Start oral therapy: amoxicillin or a macrolide if no co-morbidity; a β-lactam (co-amoxiclav or cefuroxime) ± macrolide / doxycycline if a stable co-morbidity is present. Safety-net advice and follow-up within 48–72 h.
- Moderate-risk → ward admission. Obtain blood cultures and sputum Gram stain/culture. Start an IV non-antipseudomonal β-lactam (ampicillin-sulbactam, cefotaxime, or ceftriaxone) plus a macrolide. Apply MDRO modifiers if risk factors are present.
- High-risk → ICU. Same cultures plus consideration of influenza testing in season; start an IV non-antipseudomonal β-lactam plus a macrolide (or a respiratory fluoroquinolone as the alternative). Escalate for MRSA, ESBL, or Pseudomonas risk as below.
- MDRO present: add vancomycin/linezolid/clindamycin for MRSA; replace the β-lactam with a carbapenem for ESBL; replace it with an antipseudomonal β-lactam for Pseudomonas.
- Add empiric antiviral therapy for high-risk CAP with influenza risk factors during high-activity months (July–January). Reassess at 48–72 h and de-escalate per cultures and clinical response.
Evidence & References
Risk Stratification (2020 Philippine CAP CPG)
| Parameter | Low risk | Moderate risk | High risk |
|---|---|---|---|
| Respiratory rate | < 30/min | ≥ 30/min | ≥ 30/min |
| Pulse rate | < 125/min | ≥ 125/min | ≥ 125/min |
| Systolic BP | ≥ 90 mmHg | < 90 mmHg | < 90 mmHg |
| Diastolic BP | > 60 mmHg | ≤ 60 mmHg | ≤ 60 mmHg |
| Temperature | > 36 °C and < 40 °C | ≤ 36 °C or ≥ 40 °C | ≤ 36 °C or ≥ 40 °C |
| Altered mental state (acute) | Absent | Present | Present |
| Suspected aspiration | No | Yes | Yes |
| Co-morbid condition | None or stable | Unstable / decompensated | Unstable / decompensated |
| Severe sepsis / septic shock | Absent | Absent | Present* |
| Need for mechanical ventilation | No | No | Yes* |
| Site of care | Outpatient | Ward admission | ICU admission |
*High-risk CAP = any clinical feature of moderate-risk CAP plus either severe sepsis / septic shock or a need for mechanical ventilation. Unstable / decompensated co-morbids include uncontrolled diabetes mellitus, active malignancies, neurologic disease in evolution, congestive heart failure Class II–IV, unstable coronary artery disease, renal failure on dialysis, uncompensated COPD, and decompensated liver disease.
Empiric Antibiotic Therapy
| Tier | Regimen (per 2020 CPG) |
|---|---|
| Low risk, no co-morbidity | Amoxicillin 1 g PO TID, or Clarithromycin 500 mg PO BID, or Azithromycin 500 mg PO OD (Rec 7) |
| Low risk, stable co-morbidity | β-lactam [Co-amoxiclav 500/125 mg TID or 875/125 mg BID, or Cefuroxime 500 mg BID] ± Macrolide (clarithromycin/azithromycin) or Doxycycline 100 mg BID (Rec 8) |
| Moderate risk | Non-antipseudomonal β-lactam IV [Ampicillin-sulbactam 1.5–3 g q6h, or Cefotaxime 1–2 g q8h, or Ceftriaxone 1–2 g daily] plus Macrolide (azithromycin 500 mg daily / clarithromycin 500 mg BID) (Rec 9) |
| High risk | Non-antipseudomonal β-lactam IV plus Macrolide (1st line); or the same β-lactam plus a respiratory fluoroquinolone (levofloxacin 750 mg / moxifloxacin 400 mg) as the alternative (Rec 10) |
| MRSA risk | Add Vancomycin 15 mg/kg IV q12h, or Linezolid 600 mg IV q12h, or Clindamycin 600 mg IV q8h (Rec 12) |
| ESBL risk | Replace β-lactam with Ertapenem 1 g IV q24h (or Meropenem 1 g IV q8h) + macrolide or respiratory fluoroquinolone (Rec 12) |
| Pseudomonas risk | Replace β-lactam with Piperacillin-tazobactam 4.5 g IV q6h, Cefepime/Ceftazidime 2 g IV q8h, Aztreonam 2 g IV q8h, or Meropenem 1 g IV q8h + macrolide or respiratory fluoroquinolone (Rec 12) |
Routine anaerobic coverage is not recommended for suspected aspiration unless lung abscess or empyema is suspected (Rec 11). Consider empiric antiviral therapy for high-risk CAP with influenza risk factors during high-activity months, July–January (Rec 13–14).
References
- Philippine Society for Microbiology and Infectious Diseases (PSMID), Philippine College of Chest Physicians, Philippine College of Physicians, et al. Philippine Clinical Practice Guidelines on the Diagnosis, Empiric Management, and Prevention of Community-acquired Pneumonia (CAP) in Immunocompetent Adults — 2020 Update. Manila: PSMID; 2020.
- Philippine Clinical Practice Guidelines Group. Diagnosis, Empiric Management and Prevention of Community-acquired Pneumonia in Immunocompetent Adults: 2016 Update. PSMID; 2016.
