Heckerling Clinical Decision Rule for the Diagnosis of Pneumonia

Patients are stratified on the basis of clinical information into subgroups with differing probabilities of having pneumonia and the further need for chest x-ray is determined with greater accuracy.

Temperature >37.8 °C or 100 °F
+1
Heart rate > 100 beats per minute
+1
Crackles (rales)
+1
Decreased breath sounds
+1
Absence of asthma
+1
Probability Of Having Pneumonia
0%
(Assuming a prevalence of 5%)
Based on a score of 0 out of 5
Recommendations:

Risk scores of 0-1 make pneumonia an unlikely diagnosis. Chest x-ray may not be necessary.

The following are supportive therapy suggestions.

  • Acetaminophen ER 650 mg Tab
  • Dextromethorphan-Guaifenesin 10 mg-200 mg/5 mL oral liquid
  • Benzonatate 100 mg Cap
  • Benzocaine-Menthol-Cetylpyridium 10 mg-2 mg Lozenges

Risk scores of 2-3 can be suggestive of pneumonia. A chest x-ray can help distinguish between pneumonia and other causes.

If the chest x-ray is positive, the following are antibiotic and supportive therapy suggestions.

Antibiotics: Healthy patient with no antibiotics for the last 3 months

  • Azithromycin 250 mg Tab
  • Azithromycin 500 mg Tab
  • Clarithromycin 500 mg Tab
  • Clarithromycin ER 500 mg 24 HR Tab
  • Doxycycline 100 mg Cap

Comorbid conditions or antibiotics within the last 3 months

  • Moxifloxacin 400 mg Tab
  • Levofloxacin 750 mg Tab
  • Azithromycin 500 mg Tab
  • Azithromycin 250 mg Tab
  • Amoxicillin 500 mg Cap
  • Amoxicillin 875 mg Tab
  • Cefpodoxime 200 mg Tab
  • Cefuroxime axetil 500 mg Tab

Supportive Therapies

  • Acetaminophen ER 650 mg Tab
  • Dextromethorphan-Guaifenesin 10 mg-200 mg/5 mL oral liquid
  • Benzonatate 100 mg Cap
  • Benzocaine-Menthol-Cetylpyridium 10 mg-2 mg Lozenges

If the chest x-ray is negative, the following are supportive therapy suggestions.

  • Acetaminophen ER 650 mg Tab
  • Dextromethorphan-Guaifenesin 10 mg-200 mg/5 mL oral liquid
  • Benzonatate 100 mg Cap
  • Benzocaine-Menthol-Cetylpyridium 10 mg-2 mg Lozenges

Risk scores of 4-5 are very suggestive of pneumonia. Consider a chest x-ray prior to treatment with antibiotics. The following are antibiotic suggestions.

Antibiotics : Healthy patient with no antibiotics for the last 3 months

  • Azithromycin 250 mg Tab
  • Azithromycin 500 mg Tab
  • Clarithromycin 500 mg Tab
  • Clarithromycin ER 500 mg 24 HR Tab
  • Doxycycline 100 mg Cap

Comorbid conditions or antibiotics within the last 3 months

  • Moxifloxacin 400 mg Tab
  • Levofloxacin 750 mg Tab
  • Azithromycin 500 mg Tab
  • Azithromycin 250 mg Tab
  • Amoxicillin 500 mg Cap
  • Amoxicillin 875 mg Tab
  • Cefpodoxime 200 mg Tab
  • Cefuroxime axetil 500 mg Tab