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Pneumonia: update on diagnosis and management

BMJ 2006; 332 doi: (Published 04 May 2006) Cite this as: BMJ 2006;332:1077
  1. Zara Hoare, clinical research fellow of the University of Nottingham (,
  2. Wei Shen Lim, consultant in general and respiratory medicine1
  1. Department of Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB
  1. Correspondence to: Z Hoare

    Prompt diagnosis and management of community acquired pneumonia saves lives. This article summarises the latest key recommendations in the management of pneumonia and is intended for junior doctors managing this common condition

    Why is it important?

    Community acquired pneumonia is an important healthcare concern. The annual incidence rate is 6/1000 in the 18-39 age group. This rises to 34/1000 in people aged 75 years and over. Admission to hospital is needed in 20-40% of patients with community acquired pneumonia. About 5-10% of these patients are admitted to intensive care. The overall mortality from community acquired pneumonia is 5-10%, so it is important to identify and treat patients with this disease.1 2 We will concentrate on three aspects of hospital management: assessment of disease severity, investigations, and antibiotic treatment.

    What are the symptoms and signs of pneumonia?

    Pneumonia is defined as an acute lower respiratory tract infection, together with new radiographic shadowing.1 Anybody can get pneumonia, although it is most common in elderly people. The clinical history of pneumonia may include one or more of:

    • Pleuritic chest pain

    • Shortness of breath

    • Cough

    • Production of sputum

    • Rigors or night sweats

    • Confusion.

    On examination the signs may include:

    • Raised respiratory rate

    • Fever of = 38°C

    • Focal chest signs: decreased chest expansion, dullness on percussion, decreased entry of air, bronchial breathing, and crackles (none, some, or all of these may be present).

    In elderly people, fever may not be present and new onset of mental confusion is more common.3

    Summary points

    Pneumonia is common and has high mortality

    Simple scoring systems help to distinguish between patients who can be managed at home and those who may need intensive care

    Antibiotic treatment is guided by the severity of disease

    Newer antibiotics have their place, but penicillin and macrolides (such as erythromycin) are still first …

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