Pneumonia €“ management
If a diagnosis of pneumonia is uncertain then a CRP test may help determine whether antibiotics are needed, along the same criteria as for cough.20
If an antibiotic is required, the initial course should be for five days. Treatment should start as soon as possible after diagnosis, and ideally within four hours, or within one hour if sepsis is also suspected.9,10
| Patient | Pneumonia severity | First choice antibiotic | Alternatives |
| Adults | low severity | amoxicillin | doxycycline (not under 12 years) or clarithromycin, or erythromycin (in pregnancy) |
| moderate severity | amoxicillin | doxycycline or clarithromycin (ideally after microbiological testing) | |
| + if atypical pathogens suspected | + clarithromycin or erythromycin (in pregnancy) | doxycycline or clarithromycin (ideally after microbiological testing) | |
| high severity | co-amoxiclav with clarithromycin or erythromycin (in pregnancy) | levofloxacin (consider safety issues), or consult local microbiologist if fluoroquinolones are not appropriate | |
| Children | under 1 month | refer to paediatric specialist | |
| 1 month and over – non-severe | amoxicillin | clarithromycin or doxycycline (12-17 years), or erythromycin (8-17 years and in pregnancy) | |
| severe | co-amoxiclav | consult with the local microbiologist | |
| severe and an atypical pathogen is suspected |
co-amoxiclav + clarithromycin or erythromycin |
local microbiologist |
(Adapted from NICE. Pneumonia (community-acquired): antimicrobial prescribing. NICE guideline [NG138] Section 1.2 Choice of antibiotic)
Patients with CAP should not be offered glucocorticoid treatment routinely unless indicated for any other co-morbidity.
Antibiotic choice for HAP is wider, with co-amoxiclav the first choice for non-severe symptoms, and doxycycline, cefalexin, co-trimoxazole or levofloxacin as possible alternatives. Severe HAP may require intravenous antibiotics, based on specialist microbiologist advice and local resistance data.11