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Pneumonia - severity assessment


These are guidelines only and management may vary depending on individual circumstances eg. An advanced care plan to avoid acute admissions.


  • Symptoms of an acute lower respiratory tract illness (cough and at least one other lower respiratory tract symptom)

  • New focal chest signs on examination

  • At least one systemic feature (either a symptom complex of sweating, fevers, shivers, aches and pains and/or temperature of 38°C or more).

  • No other explanation for the illness.


Chest x-ray should not be used routinely for patients with acute symptoms of community acquired pneumonia but should be considered in failure to respond to treatment or after about 6 weeks in patients with persistent signs or symptoms or who are at higher risk of malignancy eg. Age>50 or smokers.


Sputum culture is not recommended routinely for those managed in the community but should be considered if failure to respond to treatment.


British Thoracic Society Guidelines for the management of community acquired neumonia in adults update 2009 Quick reference guide


SIGN guideline 59 community management of lower respiratory tract infection in adults


Assessment of severity

Management is based on the assessment of severity of the pneumonia based on clinical judgement.

Pulse oximetry should be performed.  SpO2 <92% may indicate need for admission.

The CRB-65 score is an aid to clinical judgement:


Score 1 point for each of:

  • Confusion of recent onset

  • Respiratory rate ≥ 30 per minute

  • Low systolic BP (<90mmHg) or low diastolic BP(≤60mmHg)

  • Age 65 or over












For patients admitted to hospital with pneumonia that is felt to be life-threatening the general practitioner should give benzylpenicillin 1.2g iv or amoxicillin 1g po whilst awaiting transfer unless penicillin allergic.

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