Pneumonia: Diagnosis & Management in Primary Care Based on NICE Guideline NG250 (Published: 2 Sept 2025)

This guideline focuses on the diagnosis, assessment, and treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in patients aged >1 month. It includes updates relevant to bacterial pneumonia, including that secondary to COVID-19, but excludes ventilator-associated pneumonia and COVID-19-specific pneumonia.

Primary Care Focus

Key changes relevant to general practice include:

• Shorter antibiotic courses: 3 days (previously 5) for children aged 3 months–11 years with non-severe CAP.

• Emphasis on rational antibiotic use to combat resistance.

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• Updated diagnostic and management criteria for CAP and HAP.

This guideline replaces CG191 (2014), NG138, and NG139 (both 2019), integrating new evidence and best practice principles.

Community-Acquired Pneumonia (CAP) – Definition

• Acquired outside hospital, or within 48 hours of admission

• Includes pneumonia in nursing home residents

• Hospital confirmation usually via chest X-ray

• Diagnosis in primary care is based on clinical features and clinical judgement

Assessing Community-Acquired Pneumonia in Adults (Primary Care)

Once a clinical diagnosis of community-acquired pneumonia (CAP) is made, assessment of disease severity is essential to guide treatment location (home vs hospital) and management strategy.

NICE recommends using the CRB65 score—a validated tool that estimates 30-day mortality risk—in combination with clinical judgement to classify patients...