Acute Respiratory Infection in Adults

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Outpatient Management

For acute respiratory infections in children see Paediatric Conditions; Acute Respiratory Infections

Common cold, influenza and acute bronchitis ('cough')

No antibiotics are required. Treat symptomatically.

Other respiratory infections (Including pneumonia and other severe lower respiratory infections)

• The approach to management may be influenced by the patient's HIV status. Always exclude TB and PCP. Loss of weight, productive cough for > 3 weeks, night sweats and a fever require TB screening i.e. sputum tests and/or CXR. Take a history of the duration of symptoms, sputum production (colour, haemoptysis and volume), constitutional symptoms of anorexia, weight loss, night sweats, and pyrexia. Ask for pleuritic chest pains.
• If tuberculosis is unlikely and the patient's condition does not warrant admission, treat the infection with:

Medicine	Adult dose	Frequency	Duration
amoxicillin po	1g stat, then 500mg	3 times a day	7 days + review (Return earlier if symptoms worsen)
or, if allergic to penicillin use: erythromycin po	500mg	4 times a day	7 days

• If tuberculosis is likely arrange a sputum examination (2 sputum smear tests) and plan a review within one week.

On re-assessment, if there is no clinical improvement refer to district level. The three most common diagnosis are:

• Pneumonia - non-responding segmental/lobar (See section on inpatient management)
• Tuberculosis - Repeat sputum smear tests. Refer to the chapter on tuberculosis for treatment protocols.
• Pneumocystis Pneumonia (PCP) - Patients are usually breathless, may be breathless only on exertion early in the illness, may be cyanosed; and may have negligible chest signs. The chest x-ray typically reveals bilateral fine perihilar mid­ zone reticular-nodular infiltrates (ground grass). There may be cystic change. Frequently there are other signs of immuno-suppression.

See sections below for management. 

In-patient management

Consider admission if patient is obviously unwell, or in severe pain. Admission and close monitoring are mandatory if any of these signs are present:

• respiratory distress
• cyanosis
• pulse >124/min
• hypotension (systolic pressure < 90mmHg)
• temperature > 40°C or < 35°C
• altered mental state
• if elderly >65 years
• if patient has chronic lung disease (e.g. chronic obstructive pulmonary disease), chronic renal failure, chronic cardiac failure, chronic liver disease
• Scoring for pneumonia severity (CURB-65) (the presence of any of the following merits admission)
  • C= confusion
  • U= urea greater than 7 mmol/L
  • R= respiratory rate > or equal to 30
  • B = blood pressure less than 90/60
  • 65= age of 65 or more

Always try to obtain sputum for MCS to establish the aetiological pathogen and its sensitivity to guide antibiotic treatment after empiric therapy.