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Reviewed  22/1/2015 Dr R Cook

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


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

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