Pneumonia
Infection of the lung tissue causing cough, fever and breathlessness.
Overview
Pneumonia is inflammation of lung tissue, most often from bacterial or viral infection. Severity ranges from outpatient illness to life-threatening sepsis.
Symptoms
- • Productive cough
- • Fever, chills
- • Pleuritic chest pain
- • Breathlessness
- • Fatigue
Risk factors
- • Age >65 or <2
- • Smoking
- • COPD or asthma
- • Immunosuppression
- • Recent viral illness
Causes
- • Streptococcus pneumoniae and other bacteria
- • Influenza, RSV, COVID-19
- • Aspiration
🚨 Red flags — seek urgent care
- • Respiratory rate >30
- • Oxygen saturation <92%
- • Confusion
- • Low BP
- • Cyanosis
When to seek care
- • High fever with breathlessness
- • Coughing blood
- • Worsening symptoms after 48 hours
Diagnosis
- • Acute cough plus ≥1 of: fever, pleuritic chest pain, dyspnoea, focal chest signs
- • Chest X-ray for confirmation in moderate–severe disease or diagnostic uncertainty
- • CRP and CURB-65 (or CRB-65 in community) to grade severity
- • Microbiology: sputum culture, blood cultures, urinary antigens (Legionella, pneumococcus) in moderate–severe disease
Treatment
- • CRB-65 0 (low risk): amoxicillin 500 mg TDS for 5 days (doxycycline/clarithromycin if penicillin-allergic)
- • CRB-65 1–2 (moderate): dual therapy with amoxicillin + macrolide for 5–7 days
- • CRB-65 3–4 (severe): hospital IV antibiotics (e.g. co-amoxiclav + clarithromycin), oxygen, IV fluids
- • Atypical cover (macrolide or doxycycline) when atypical pathogens suspected
- • Review at 48–72 h; escalate if not improving
Prevention
- • Annual influenza vaccine; pneumococcal vaccine for at-risk groups and adults ≥65
- • Smoking cessation
- • COVID-19 vaccination per current schedule
- • Hand hygiene; treat dental disease
Complications
- • Parapneumonic effusion and empyema
- • Lung abscess
- • Sepsis and septic shock
- • Respiratory failure (Type 1)
- • Post-pneumonia chronic fatigue / cardiovascular events
Education & self-care
Vaccination against pneumococcus and influenza substantially reduces risk, particularly in older adults and those with chronic disease.
Frequently asked questions
Do I always need antibiotics?
Bacterial pneumonia needs antibiotics. Viral pneumonia is treated supportively.
How long does recovery take?
Cough and fatigue often persist 3–6 weeks even after successful treatment.
How long is recovery?
Cough and fatigue can persist for weeks even after antibiotics finish. Chest X-ray changes can take 6 weeks or more to clear; a follow-up X-ray is often offered to confirm resolution.
Do I need to be in hospital?
Most community-acquired pneumonia is treated at home. Severity scores (CRB-65 or CURB-65) and oxygen saturation help decide who needs admission.
Can pneumonia be prevented?
Pneumococcal and annual flu vaccines significantly reduce risk in older adults, smokers and those with chronic disease. Stopping smoking is the single most effective preventive measure.