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Chest infections - adult - Management
Overview of management

  • Provide self-care advice advice. For most people, adequate hydration, analgesia, and comfort measures are adequate. People who smoke should be encouraged to quit and given the necessary support and treatment to do so.
  • Antibiotics are not routinely indicated.
    • Consider prescribing an antibiotic if the person has a significantly impaired ability to fight infection (e.g. immunocompromised status, cancer, or physical frailty) or if acute bronchitis is likely to significantly worsen a pre-existing condition (e.g. heart failure, angina, or diabetes).
      • If an antibiotic is necessary, prescribe amoxicillin first-line, or doxycycline as an alternative. Consider a macrolide (erythromycin or clarithromycin) if amoxicillin or doxycycline are unsuitable.
    • A delayed antibiotic prescribing strategy may be considered for people with acute bronchitis where it is felt safe not to prescribe antibiotics immediately.
  • Routine follow up is unnecessary. Re-examine people who have deteriorated to exclude pneumonia. For people with a pre-existing condition that has deteriorated on treatment, consider admission or a second-line antibiotic depending on clinical judgement:
    • Co-amoxiclav or doxycycline are options in people who have already received amoxicillin.
    • If these are unsuitable, seek specialist advice from a microbiologist.

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