Acute GP service

Pneumonia Management

 

 

• Early administration of antibiotics is essential.

• For patients presenting with symptoms of LRTI in primary care if after clinical assessment a diagnosis of pneumonia has not been made consider point of care testing of CRP(or lab CRP if seen in acute GP clinic)

  • CRP<20 Do not routinely offer antibiotics.

  • CRP 20-100 Consider delayed prescription

  • CRP>100 offer antibiotics

NICE guidance CG191: Pneumonia

• Maintain fluid balance. Rest, drink plenty of fluids and do not smoke.

• Give simple analgesia for pleuritic pain eg. paracetamol .

• Consider oxygen prescription if SpO2<92% and admission not appropriate. Home oxygen can be arranged within 4 hours via HOOF form.

• Review within 48hours or earlier if clinically indicated. Consider CXR if not improving

​

Antibiotic treatment

 

• Please see the CPFT Adult Antimicrobial Guide and NICE guidance CG191: Pneumonia

 

Duration of antibiotics

 

• Uncomplicated non-severe pneumonia treat for 5 days and extend if inadequate improvement after 3 days.

• Moderate - severe pneumonia without identified organism treat for 7-10 days, increased to 14-21 days if suspected/confirmed legionella,staphylococcal, or gram –ve enteric bacilli.

• Convert iv antibiotics to oral once improving based on:

  • Resolution of fever for >24hours

  • Pulse rate <100

  • Resolution of tachypnoea

  • Clinically hydrated and taking oral fluids

  • Absence of hypotension

  • Absence of hypoxia

  • Improving white cell count

  • Non-bacteraemic infection

  • No microbiological evidence of legionella, staphylococcal or gram –ve enteric bacilli infection

  • No concerns over gastro-intestinal absorption

 

NICE guidance CG191: Pneumonia

​