Published
Community-acquired pneumonia — assessment, diagnosis and antibiotic prescribing ACG
Condition
Infectious diseases
Guidance type
ACG
21 September 2026
Published on 21 September 2026
This ACE Clinical Guideline (ACG) covers the assessment, diagnosis, and appropriate antibiotic prescribing for community-acquired pneumonia (CAP) in the community setting, especially those providing primary or generalist care. The ACG offers evidence-based recommendations on the clinical diagnosis of CAP based on signs and symptoms, severity assessment, and empirical antibiotic therapy. It also includes advice for patients and carers on self-monitoring and care escalation when needed, as well as guidance on follow-up consultation depending on individual patient circumstances.
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Community-acquired pneumonia — assessment, diagnosis and antibiotic prescribing (pending publication) [WEB]
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ACG recommendations
1a. Diagnose community-acquired pneumonia (CAP) based on clinical signs and symptoms.
1b. Order a chest X-ray if:
the diagnosis cannot be made based on clinical signs and symptoms alone, or
other serious respiratory conditions are suspected.
2 . Use the CRB-65 tool to help inform whether a patient with non-severe CAP should be treated in the community or hospital setting.
3 . Do not routinely conduct microbiological testing for patients who are deemed suitable for treatment in the community setting.
4 . Prescribe empirical antibiotic therapy for patients with non-severe CAP:
Use amoxicillin for patients at low risk of complications.
Use amoxicillin + clavulanic acid for patients at higher risk of complications.
Use doxycycline, azithromycin or clarithromycin as an alternative antibiotic for patients with penicillin or beta-lactam allergy.
5a. Ask patients and carers to monitor the symptoms and seek immediate medical attention if the condition does not improve or worsens.
5b. Schedule a follow-up consultation for patients with non-severe CAP if required, prioritising those at high risk of complications.
ACG references and Expert Group details
CAP ACG references (Sep 2026) [PDF, 138.16 KB] (opens in new tab)
CAP ACG EG composition and other details (Sep 2026) [PDF, 99.06 KB] (opens in new tab)
ACG EtR framework
The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values, acceptability and other considerations.
CAP EtR framework with summary of findings (Sep 2026) [PDF, 315.51 KB] (opens in new tab)
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