Pneumonia is a term which describes inflammation of the lung parenchyma characterised by exudation and consolidation into the alveoli.
There are various ways of categorising the pneumonias:
- by who gets them and when
- by the causative organism
- by the geography of acquisition
Overall (in the UK), Streptococcus pneumoniae is by far the most common agent.
- community-acquired pneumonia has an annual incidence of 5 to 10 per 1,000 adult population, and accounts for 5% to 12% of all lower respiratory tract infections managed by GPs in the community
- between 22% and 42% of people with community-acquired pneumonia will require hospital-based care
- hospital-acquired pneumonia occurs in around 0.5% to 2% of hospitalisations and is a common cause of morbidity and mortality
- the presence of hospital-acquired pneumonia increases hospital stays by an average of 7 to 9 days per person and accounts for a large number of antibiotics prescribed
- pneumonia accounts for 29,000 deaths per year in the UK, and 5% to 15% of people hospitalised with community-acquired pneumonia die within 30 days of admission, rising to 30% for those admitted to an intensive care unit
- more than half of pneumonia-related deaths occur in people older than 84 years
Start antibiotic treatment as soon as possible after establishing a diagnosis of community-acquired pneumonia, and within 4 hours of presentation to hospital (1):
For adults with community-acquired pneumonia, stop antibiotic treatment after 5 days
- unless microbiological results suggest a longer course is needed or
- the person is not clinically stable, for example, if they have had a fever in the past 48 hours or have more than 1 of the following signs of clinical instability:
- systolic blood pressure less than 90 mmHg
- heart rate more than 100 beats per minute
- respiratory rate more than 24 breaths per minute
- oxygen saturations of less than 90% on room air (or failure to meet long-term baseline oxygen requirements); note that oxygen saturation monitors may be inaccurate in people with pigmented skin
Offer a 3‑day course of antibiotics for babies and children aged 3 months (corrected gestational age) to 11 years with non-severe community-acquired pneumonia without complications or underlying disease (1):
- consider extending use of antibiotics beyond 3 days for babies and children aged 3 months (corrected gestational age) to 11 years if they are not clinically stable, for example, if they are in respiratory distress or their oxygen saturation levels have not improved as expected
- for all children and young people with community-acquired pneumonia, stop antibiotic treatment after 5 days unless microbiological results suggest a longer course is needed or the child or young person is not clinically stable
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