CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Chest infections - adult - Management
How should I follow up a person with pneumonia?
- Regularly reassess the key clinical features used in the CRB-65 system and the person's ability to cope at home. Follow up until clinical features of the pneumonia have resolved.
- For people having difficulty coping at home — offer admission.
- For people whose CRB-65 score deteriorates on treatment — arrange admission.
- For people whose CRB-65 score does not improve despite antibiotic treatment — further management will depend on clinical judgement. The options are either arrange admission, or add in or switch to a second antibiotic.
- For people prescribed amoxicillin, switch to, or add in, a macrolide.
- If amoxicillin was not initially used, seek advice from a microbiologist or respiratory physician.
- Arrange a chest X-ray after 6 weeks for all people:
- With symptoms and signs that are slow to resolve or persist despite treatment.
- Who smoke and are over 50 years of age.
- Advise people that smoke to quit and offer them support to do so. See the CKS topic on Smoking cessation.
- Following recovery from pneumonia, consider whether pneumococcal or influenza immunization is necessary. See the CKS topics on Immunizations - seasonal influenza and Immunizations - pneumococcal.
© NHS Institute for Innovation and Improvement