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CHEST INFECTION - Coggle Diagram

- - - - Community-acquired pneumonia Has a mortality rate of less than 1% in people who are managed in primary care
      - Mortality ranges from 5–14% in people requiring admission to hospital, and rises to more than 30% in people requiring intensive care
      - Complications include pleural effusion and empyema, lung abscess, acute respiratory distress syndrome, septic shock, and disseminated infection
- - - - Chronic cough (more than 8 weeks' duration):
      - A range of diseases are associated with chronic cough, however, the majority of people have a common clinical presentation — sensitivity to inhalation of environmental irritants. Cough hypersensitivity syndrome is the umbrella term used to describe the excessive stimulation of the normal cough reflex caused by thermal, chemical, or mechanical stimulation.
      - Chronic cough is most commonly caused by exposure to cigarette smoke (either actively or passively), upper airway cough syndrome, asthma, eosinophilic bronchitis, gastro-oesophageal reflux disease, or use of an angiotensin-converting enzyme (ACE) inhibitor.
      - More than one cause of chronic cough is often present.
    - - Bronchiectasis.
        
        Bronchitis.
        
        Chronic obstructive pulmonary disease.
        
        Cough variant asthma.
        
        Environmental or occupational causes.
        
        Foreign body aspiration.
        
        Heart failure.
        
        Interstitial lung disease.
        
        Lung cancer.
        
        Obstructive sleep apnoea.
        
        Pertussis.
        
        Pulmonary tuberculosis.
        
        Somatic cough syndrome.
        
        Thoracic aortic aneurysm.
- - - - For people identified at a face-to-face clinical examination as systemically very unwell, offer an immediate antibiotic — doxycycline 200 mg on the first day, then 100 mg once daily for 4 days (avoid in pregnancy). Or if this is not suitable, alternatives are:
      - Amoxicillin 500 mg three times daily for 5 days.
      - Clarithromycin 250 mg to 500 mg twice daily for 5 days.
      - Erythromycin 250 mg to 500 mg four times daily (or 500 mg to 1000 mg twice daily) for 5 days.
      - For people identified as at higher risk of complications, consider:
        
        An immediate antibiotic.
        
        A back-up antibiotic prescription — give advice that it is not needed immediately and to use it if symptoms worsen rapidly or significantly at any time.
        
        When an antibiotic is given, give advice about possible adverse effects, particularly diarrhoea and nausea.
      - COVID-19 — follow the Public Health England advice for managing people with COVID-19 in primary care
      - Do not prescribe doxycycline in:
        
        Women who are pregnant or breastfeeding. Tetracyclines are deposited in growing bone and teeth which can result in discolouration of teeth and occasionally dental hypoplasia.
        
        Prescribe doxycycline with caution in people with:
        
        Hepatic impairment and those receiving potentially hepatotoxic drugs.
        
        Myasthenia gravis — tetracyclines may increase muscle weakness in people with myasthenia gravis.
        
        Systemic lupus erythematosus (SLE) — tetracyclines may exacerbate SLE symptoms.
        
        Renal impairment — avoid excessive doses.
- - - - Consider referring adults with community-acquired pneumonia to hospital, or seek specialist advice if:
      - There is bacterial resistance to oral antibiotics, or
      - The person is unable to take oral medication.
      - Use clinical judgement in addition to the CRB-65 score to decide if an adult should be admitted. Other factors that should also be considered include:
        
        The person's wishes.
        
        Social support available.
        
        Pre-existing comorbid conditions and general frailty.
        
        If the person is pregnant.
        
        Pulse oximetry.
      - Use the CRB-65 score to help decide whether an adult with suspected community-acquired pneumonia requires hospital admission (for more information, see the section on How should I assess a person with a suspected chest infection?).
        
        Score of 3 or more, arrange urgent admission to hospital.
        
        Score of 1 or 2, hospital assessment should be considered (particularly for people with a score of 2).
        
        Score of 0, treatment at home should be considered, depending on clinical judgement and the person's social circumstances.