Prescribing With Precision: Aligning CURB-65 scores with Antibiotic Protocol in Community Acquired Pneumonia

Abstract Background: Community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality, particularly among older adults. The CURB-65 severity score is a validated tool to guide empirical antibiotic therapy in CAP. This clinical audit aimed to evaluate the adherence to CURB-65-based antibiotic prescribing guidelines at a UK hospital and to assess the impact of audit-feedback interventions on prescribing behaviour. Methods: A prospective two-cycle audit was conducted at Walsall Manor Hospital. Each cycle included 50 adult patients admitted with suspected or confirmed CAP. Empirical antibiotic prescriptions were assessed for compliance with hospital guidelines based on CURB-65 scores. Compliance was categorized as correct, higher-grade (overtreatment), or lower grade (under treatment). Interventions between cycles included educational sessions and enhanced access to local guidelines. Data were analysed using chi-square and t-tests. Results: Antibiotic administration in the ward was similar between cycles, with 90.0% (n = 45) of patients receiving antibiotics in Cycle 1 and 96.0% (n = 48) in Cycle 2 (p = 0.240). Guideline-concordant antibiotic use improved from 58.0% (n = 29) in Cycle 1 to 68.0% (n = 34) in Cycle 2, although this was not statistically significant (p = 0.300). Among the 37 patients who received non-concordant antibiotics, the majority were over treated with higher-grade regimens-85.7% (n = 18) in Cycle 1 and 87.5% (n = 14) in Cycle 2. Under treatment was minimal and comparable between cycles (14.3% vs. 12.5%; p = 0.875). Conclusion: Audit-feedback interventions led to a modest improvement in adherence to CURB-65-guided antibiotic prescribing, particularly by reducing under treatment. However, overtreatment remained prevalent, highlighting a persistent clinical tendency toward broad-spectrum antibiotic use. Multifaceted interventions targeting clinician education and decision support may enhance guideline adherence and promote antimicrobial stewardship.