g logo nice orange

Pneumonia in adults: diagnosis and management—information for the public

  • The following information is taken from the Information for the public section of NICE Clinical Guideline 191 Pneumonia in adults: diagnosis and management and is intended to be used in consultation with patients. The information can also be printed out for patients to take away and refer to

Pneumonia

  • Pneumonia is a type of chest infection. There are several different types of chest infection (including bronchitis), which can vary in severity. Pneumonia is caused by an infection of tiny air sacs in the lungs. When you have pneumonia these air sacs become inflamed (swollen) and filled with fluid. This makes it hard for your lungs to work properly

  • The main symptom of pneumonia is usually a new cough along with at least 1 other symptom, such as:

    • bringing up phlegm

    • fever

    • breathlessness or difficulty breathing

    • chest discomfort or pain

  • Doctors usually diagnose pneumonia by asking about your symptoms and examining your chest. If you are in hospital a chest X-ray is usually carried out to confirm the diagnosis

  • Most pneumonia develops outside hospital, in the community (sometimes described as community-acquired pneumonia). However, sometimes people develop pneumonia while they are in hospital with another problem (called hospital-acquired pneumonia)

  • Most of the information here is for people who develop pneumonia outside hospital, although there is some information about treating pneumonia that starts in hospital (see pneumonia that develops in hospital)

If you go to your GP with a chest infection

  • Symptoms of pneumonia are often very similar to those of other chest infections

  • If you go to your GP with symptoms of a chest infection it might not be clear whether you have pneumonia, even after your doctor has asked about your symptoms and examined your chest

  • If it’s not clear whether you have pneumonia or another chest infection, you may be offered a blood test (called a C-reactive protein or CRP test) to help decide whether you need antibiotics. This test can be carried out quickly in the GP’s surgery and only needs a few drops of blood

Treating pneumonia

  • If you have pneumonia, your doctor should assess how serious it is using your age, the symptoms you have and your blood pressure. This will help your doctor to decide whether you should be looked after at home or in hospital (although your doctor should also take into account other things that might affect where you should be cared for, such as any other health problems you have and whether you have support at home). It will also help your doctor to decide what treatment you should have

Tell your doctor if you are allergic to penicillin

Treatment for mild pneumonia

  • If your pneumonia is mild (also called low severity), it may be possible for you to be cared for at home without any more tests

  • You should be offered a 5-day course of antibiotics as soon as possible after diagnosis. This should usually be a type of penicillin called amoxicillin, unless you are allergic to penicillin

Tell your doctor if you don’t start feeling better after taking antibiotics for 3 days, or at any time if you start to feel worse

  • If you’re not feeling better within 3 days of starting your antibiotics, you may have to take them for longer than 5 days

  • If you have mild pneumonia, you shouldn’t usually be offered 2 different antibiotics to take at the same time, or a type of antibiotic called a uoroquinolone

More severe pneumonia

  • If your pneumonia is more severe (called moderate or high severity), you may need to go into hospital for treatment. You should be offered blood and sputum (phlegm) tests, and possibly a urine test, to help find out what is causing your infection

  • You should be offered antibiotics as soon as possible after diagnosis. If you are admitted to hospital this should be within 4 hours of admission

  • Treatment should usually be with 2 different antibiotics at the same time, and you may need to take the antibiotics for 7 to 10 days (although you may not need to stay in hospital for that long)

  • If you are being treated in hospital, one of the tests that you may be offered when you are first admitted is a blood test called a C-reactive protein (or CRP test). Your doctor should repeat this test if you are not getting better or your symptoms are worse after 2 or 3 days of antibiotics

  • You shouldn’t usually be offered treatment with a drug called a glucocorticosteroid (more often known as a steroid) unless you need it for another condition

What to expect after starting your antibiotics

  • Your doctor should explain to you that your symptoms should start to improve after taking antibiotics, but that some people get better quicker than others and this may depend on how severe your pneumonia is
  • You should expect that after: 
    • 1 week your fever should be gone
    • 4 weeks your chest will feel better and you will produce less phlegm
    • 6 weeks you will be coughing less and finding it easier to breathe
    • 3 months most of your symptoms will be gone, but you may still feel tired
  • By 6 months you should feel back to normal

Tell your doctor if you think your symptoms are getting worse or if they’re not improving as expected

Before you leave hospital

  • If you are being cared for in hospital, your doctor or nurse should carry out some checks to help decide when you can go home

  • You shouldn’t usually be discharged if you have had 2 or more of the following problems in the past 24 hours:
    • a high temperature
    • a fast heart or breathing rate
    • a low amount of oxygen in your blood
    • low blood pressure
    • confusion
    • difficulty eating without help
  • You might also have to stay longer in hospital if you have a temperature over 37.5°C

If you develop pneumonia while in hospital

  • If you develop pneumonia while you’re in hospital or just after you’re discharged, your treatment may be slightly different. This is because the types of infection that develop in hospitals are often different from those that develop outside hospitals

  • You should be offered antibiotics as soon as possible (and within 4 hours of diagnosis). Your doctor should choose which antibiotics you should take according to local guidelines. You may need to take a 5- to 10-day course of antibiotics

full document available from…

National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT

www.nice.org.uk/guidance/cg191/ifp 

National Institute for Health and Care Excellence.

Pneumonia in adults: diagnosis and management—information for the public. December 2014.

First included: November 2017.