Overview
This guideline covers diagnosing, assessing, and treating community-acquired and hospital-acquired pneumonia, including bacterial pneumonia secondary to COVID-19, in babies over 1 month (corrected gestational age), children, young people and adults. It aims to optimise antibiotic use and reduce antibiotic resistance.
Important changes to practice in this update include:
- a change to the course length of antibiotics from 5 days to 3 days, for babies and children aged 3 months (corrected gestational age) to 11 years with non-severe community-acquired pneumonia without complications or underlying disease
- new recommendations on using corticosteroids for adults in hospital with high-severity community-acquired pneumonia.
The guideline does not cover ventilator-associated pneumonia or COVID-19 pneumonia. For recommendations on managing suspected or confirmed COVID-19 pneumonia, see NICE's guideline on managing COVID-19.
For bacterial infection in healthy babies up to and including 28 days (corrected gestational age), see NICE’s guideline on neonatal infection: antibiotics for prevention and treatment.
Last reviewed: 02 September 2025
We have reviewed the evidence on diagnosing, assessing and treating community-acquired and hospital-acquired pneumonia. For more information, see the update information.
This guideline updates and replaces NICE guideline CG191 (published December 2014), and antimicrobial prescribing guidelines NG138 and NG139 (both published September 2019).
Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.
How we prioritise updating our guidance
Decisions about updating our guidance are made by NICE’s prioritisation board. For more information on the principles and process, see NICE-wide topic prioritisation: the manual.
For information about individual topics, including any decisions affecting this guideline, see the summary table of prioritisation board decisions.
Recommendations
This guideline includes new and updated recommendations on:
- assessing community-acquired pneumonia
- investigations in hospital
- antibiotic treatment for community-acquired pneumonia
- corticosteroid treatment in hospital
- non-invasive respiratory support
- information for parents or carers of children with community-acquired pneumonia
- use of biomarkers after starting treatment
- follow-up chest X-rays
These supplement the existing recommendations on:
See also the visual summaries on:
- Community-acquired pneumonia (children and young people)
- Community-acquired pneumonia (adults presenting to primary care)
- Community-acquired pneumonia (adults presenting to hospital)
- Hospital-acquired pneumonia
Who is it for?
- Healthcare professionals
- People who have suspected or confirmed pneumonia (except ventilator-associated and COVID-19 pneumonia), their families and carers
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.