Health condition · Clinically reviewed
Pneumonia, community-acquired pneumonia, plainly.
Infection of the lung tissue — mild cases treated at home, severe cases need hospital. CURB-65 helps guide where and how to treat.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, British Thoracic Society and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects UK guidance on CURB-65 scoring, first-line antibiotics and post-illness follow-up.
Key facts
Pneumonia at a glance.
The essentials, in plain English — what it is, what causes it, how it is diagnosed, and how it is treated in the UK today.
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What it is
Infection of the lung parenchyma (alveoli and surrounding tissue) causing consolidation, cough, fever and breathlessness.
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Common causes
Bacterial (Streptococcus pneumoniae most common), viral (influenza, COVID, RSV) and atypical (Mycoplasma, Legionella).
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Severity scoring
CURB-65 stratifies risk — Confusion, Urea, Respiratory rate, Blood pressure, age ≥65.
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Diagnosis
Confirmed on chest X-ray showing consolidation, alongside clinical features and blood markers.
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Where it is treated
Home vs hospital decision based on severity — most mild cases are treated with oral antibiotics at home.
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Prevention
Pneumococcal, influenza and COVID vaccines reduce the risk of pneumococcal and post-viral pneumonia.
Why this guide matters
Severity decides where you are treated.
Most pneumonia is treated well with oral antibiotics at home — but recognising severity early is what prevents deterioration.
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CURB-65 guides the decision
A simple bedside score decides whether home antibiotics, hospital, or intensive care is right.
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First-line is usually amoxicillin
Uncomplicated community-acquired pneumonia responds to a short course of oral amoxicillin.
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Vaccines prevent it
Pneumococcal, flu and COVID vaccines together reduce the risk substantially.
How the diagnosis is made
From first symptoms to a clear plan.
The steps a UK GP or hospital team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History, vitals and chest examination
Phase 2 · Confirming
Chest X-ray, bloods and sputum culture
Phase 3 · Managing
CURB-65 and home vs hospital plan
- 01
Recognising
Symptom + risk history
Onset, cough, sputum, breathlessness, chest pain, age, comorbidities, smoking and recent viral illness.
- 02
Recognising
Vital signs (RR, sats, BP)
Respiratory rate, oxygen saturations, blood pressure, heart rate and temperature — the earliest severity signals.
- 03
Recognising
Chest examination
Focal crackles, bronchial breathing or dullness on percussion point to consolidation.
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Confirming
Chest X-ray
Confirms consolidation and helps exclude other diagnoses such as heart failure or effusion.
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Confirming
Blood tests (WCC, CRP, U&Es)
Inflammatory markers, renal function and urea — the U in CURB-65 severity scoring.
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Confirming
Sputum culture if severe
Guides antibiotic choice when illness is severe, admitted, or not responding.
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Managing
CURB-65 + management plan
Confusion, urea >7, RR ≥30, BP low, age ≥65 — the score decides home vs hospital care.
Typical timeline: same-day diagnosis, with treatment started immediately.
Symptoms
What pneumonia actually feels like.
Classic features are cough, fever and breathlessness — but older adults may present very differently. Here is what to look for.
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Productive cough
A new cough — often bringing up sputum within the first days of illness.
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Fever
Fever, sweats or shivers — often high and abrupt in bacterial pneumonia.
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Breathlessness
Feeling breathless at rest or on mild exertion — a key severity marker.
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Sputum (rust, green)
Rust-coloured or green sputum — classic of bacterial pneumonia.
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Pleuritic chest pain
Sharp chest pain worse on deep breaths or coughing — from inflamed pleura.
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Flu-like prodrome
A viral-feeling illness for a few days that then worsens — secondary bacterial pneumonia is common.
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Older adult: subtle signs
Confusion, falls, or poor oral intake may be the only clue in older adults — fever may be absent.
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Red flag: severe features
RR >30, oxygen sats <92%, confusion or systolic BP <90 — call 999.
Treatment
How pneumonia is treated in the UK.
Antibiotics tailored to severity, oxygen and fluid support when needed, plus vaccination to prevent the next episode.
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Amoxicillin (first-line uncomplicated)
Oral amoxicillin for 5 days is the standard first-line treatment for mild community-acquired pneumonia.
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Doxycycline or macrolide
Alternative first-line for patients with penicillin allergy — also covers atypical organisms.
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Co-amoxiclav (moderate severity)
Broader-spectrum oral option, often combined with a macrolide in moderate CAP.
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IV antibiotics (hospital)
For severe pneumonia, sepsis or failed oral therapy — IV co-amoxiclav plus macrolide is typical.
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Oxygen therapy
Titrated to maintain sats 94–98% (88–92% in COPD) — a cornerstone of hospital care.
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Fluid support
Oral fluids at home; IV fluids in hospital if dehydrated or septic.
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Follow-up chest X-ray in 6 weeks
Recommended in older adults, smokers and those with persistent symptoms to exclude underlying disease.
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Pneumococcal, flu and COVID vaccines
Prevention matters — vaccines reduce pneumococcal and post-viral pneumonia across life.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or hospital team knows your history and can tell you which parts apply to you. If in doubt, seek review.
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NICE. Pneumonia in adults: diagnosis and management (CG191).
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British Thoracic Society. Guideline for the management of community-acquired pneumonia in adults.
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NHS. Pneumonia — patient information.
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Public Health England / UK Health Security Agency. Pneumococcal vaccination guidance.
Red flags
When pneumonia becomes an emergency.
Most pneumonia recovers well with antibiotics. These are the situations where you should act today.
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Severe breathlessness
Struggling for breath at rest — call 999.
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Cyanosis
Blue lips or fingertips — a sign of low oxygen. Call 999.
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Confusion
New confusion or drowsiness — a severity marker and part of CURB-65. Seek urgent care.
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Persistent high fever despite antibiotics
Not settling after 48–72 hours of treatment — return for review.
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Haemoptysis
Coughing up blood — needs urgent assessment.
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Chest X-ray consolidation not resolving
Persistent shadowing at 6 weeks — needs further imaging and specialist review.
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Post-influenza secondary bacterial pneumonia
Worsening after apparent flu recovery — a well-recognised and serious pattern.
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Immunosuppression
On chemotherapy, steroids or with HIV — lower threshold for admission and broader antibiotics.
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Failure to thrive in older adults
Reduced eating, drinking or mobility — a common presentation and reason to admit.
Recovery
Recovery takes longer than people expect.
Four things that make the biggest difference to recovery and to preventing the next episode.
A quiet reminder
Tiredness lingers — that is normal.
Feeling wiped out for weeks after pneumonia is expected. Return for review if you are getting worse rather than slowly better.
- 01 Recovery
Expect a long tail
Fatigue and cough can linger for weeks after the infection clears — this is normal recovery, not treatment failure.
- 02 Follow-up
Chest X-ray at 6 weeks
Recommended for older adults, smokers or persistent symptoms to exclude underlying lung disease.
- 03 Vaccines
Prevent the next one
Pneumococcal, flu and COVID jabs reduce the risk of another episode — available on the NHS.
- 04 Smoking
Stopping helps healing
Stopping smoking accelerates recovery and lowers the chance of recurrence — support is free via the NHS.
Frequently asked
Everything we get asked about pneumonia.
Quick answers on CURB-65, antibiotics, chest X-rays, recovery time and when to worry.
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What is CURB-65?
A five-point severity score for community-acquired pneumonia — Confusion, Urea >7 mmol/L, Respiratory rate ≥30, systolic BP <90 or diastolic ≤60, age ≥65. Higher scores guide the decision between home, hospital and intensive care.
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How long does pneumonia take to recover from?
Most people improve within a week of antibiotics, but cough and fatigue can linger for 4–6 weeks. Older adults and severe cases can take longer.
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Do I always need a chest X-ray?
In UK primary care, mild suspected pneumonia can be treated without imaging. A chest X-ray is standard for anyone unwell enough to be admitted, or when the diagnosis is uncertain.
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Which antibiotic will I get?
For mild community-acquired pneumonia, amoxicillin for 5 days is first-line. Doxycycline or a macrolide is used if you are allergic to penicillin. Hospital care uses broader IV combinations.
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When should I go to hospital?
Call 999 if breathing is severely difficult, lips are blue, you become confused, or your blood pressure drops. Otherwise, contact your GP or 111 if you are getting worse rather than better on treatment.
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Can vaccines prevent pneumonia?
Yes — the pneumococcal vaccine protects against the most common bacterial cause, and flu and COVID vaccines reduce viral illness that often precedes bacterial pneumonia.
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