Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Presentation with lower respiratory tract infection

  • For people presenting with symptoms of lower respiratory tract infection in primary care, consider a point of care C‑reactive protein test if after clinical assessment a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. Use the results of the C‑reactive protein test to guide antibiotic prescribing in people without a clinical diagnosis of pneumonia as follows:

    • Do not routinely offer antibiotic therapy if the C‑reactive protein concentration is less than 20 mg/litre.

    • Consider a delayed antibiotic prescription (a prescription for use at a later date if symptoms worsen) if the C‑reactive protein concentration is between 20 mg/litre and 100 mg/litre.

    • Offer antibiotic therapy if the C‑reactive protein concentration is greater than 100 mg/litre.

Community-acquired pneumonia

Microbiological tests

  • For patients with moderate‑ or high‑severity community‑acquired pneumonia:

    • take blood and sputum cultures and

    • consider pneumococcal and legionella urinary antigen tests.

Timely diagnosis and treatment

  • Put in place processes to allow diagnosis (including X‑rays) and treatment of community‑acquired pneumonia within 4 hours of presentation to hospital.

Antibiotic therapy

Low-severity community-acquired pneumonia
  • Offer a 5‑day course of a single antibiotic to patients with low‑severity community‑acquired pneumonia.

  • Do not routinely offer patients with low‑severity community‑acquired pneumonia:

    • a fluoroquinolone

    • dual antibiotic therapy.

Patient information

  • Explain to patients with community‑acquired pneumonia that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia, and most people can expect that by:

    • 1 week: fever should have resolved

    • 4 weeks: chest pain and sputum production should have substantially reduced

    • 6 weeks: cough and breathlessness should have substantially reduced

    • 3 months: most symptoms should have resolved but fatigue may still be present

    • 6 months: most people will feel back to normal.

  • Information Standard