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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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
Overview of management
- Assess the person's need for admission by determining respiratory rate, blood pressure, age (65 years of age and older), and whether they are confused (the 'CRB-65' scale).
- If admission is not indicated, arrange a chest X-ray for people over 50 years of age that smoke, and give advice on self-care such as using analgesia and keeping hydrated. People who smoke should be encouraged to quit and given the necessary support and treatment to do so. Treat with an antibiotic.
- Amoxicillin is first-line.
- A macrolide (erythromycin, clarithromycin, or azithromycin) is indicated if amoxicillin is contraindicated.
- Doxycycline can be used if there is an epidemic of Mycoplasma pneumoniae.
- Follow up all people with pneumonia. If they have not clinically improved or are worsening on treatment, reconsider the need for admission.
- For people not requiring admission consider a second-line antibiotic:
- For people who have received amoxicillin previously, switch to, or add on, a macrolide (erythromycin or clarithromycin).
- If these are not suitable seek expert advice from a microbiologist.
- Arrange a chest X-ray after 6 weeks for people over 50 years of age that smoke, and for people with persistent symptoms or signs of pneumonia.
© NHS Institute for Innovation and Improvement