This guideline covers assessment of people aged 16 and over with symptoms and signs of acute respiratory infection (bacterial or viral) at first remote or in-person contact with NHS services. It also covers the initial management of any infections. It aims to support healthcare practitioners in making sure that people’s treatment follows the best care pathway. It forms part of a suite of work on virtual wards being undertaken by NICE.

This guideline should be read alongside NICE’s antimicrobial prescribing guidelines on:

In November 2023, we amended our guidance to clarify that the threshold for treatment or referral for further assessment may be lower for people with an acute respiratory infection who are more likely to have a poor outcome.


This guideline includes recommendations on:

Who is it for?

  • Healthcare practitioners
  • People aged 16 and over with suspected acute respiratory infection, their families and carers

Guideline development process

How we develop NICE guidelines

This guideline replaces recommendation 1.1.1, and updates recommendations 1.2.1 and 1.2.2 from NICE guideline CG191 (published December 2014).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)