Pneumonia & Pulmonary Tuberculosis
Assess respiratory infection severity, select meaningful samples and plan treatment, isolation and review.
Quick revision ↓ Medical Dictionary
01Assess pneumonia severity
Cough, fever, breathlessness and pleuritic pain suggest lower respiratory infection, but presentation can be atypical in older or immunocompromised adults. Check oxygenation, respiratory effort, blood pressure, confusion and oral intake. Severity scores can support judgement but do not replace it. A patient who is hypoxaemic, hypotensive or unable to maintain hydration may require urgent hospital care despite an apparently modest score.
02Investigate the clinical problem
Chest imaging supports diagnosis and can reveal complications or alternatives such as oedema, malignancy or pleural disease. Blood tests and microbiological samples depend on severity and setting. Obtain useful cultures before antibiotics when feasible without delaying urgent treatment. Interpret a positive respiratory sample in context because colonisation is possible. Reconsider pulmonary embolism and other diagnoses if the overall picture does not fit infection.
03Treatment and reassessment
Choose antimicrobials through local guidance, considering severity, recent antibiotics, allergies, aspiration risk and resistance patterns. Support oxygenation and hydration while avoiding fluid overload. Review clinical response, culture results and opportunities to narrow or stop treatment. Persistent fever or deterioration may reflect resistant organisms, inadequate source control, empyema, an incorrect diagnosis or another complication; simply extending the same prescription is not an adequate review.
04Recognise tuberculosis
Prolonged cough, weight loss, night sweats, haemoptysis or exposure history should raise suspicion for tuberculosis, with a lower threshold in vulnerable groups. Symptoms and radiographs alone cannot reliably determine microbiological status or drug resistance. Use the national TB programme and appropriate rapid molecular testing and specimens. Consider extrapulmonary disease when symptoms arise outside the lungs rather than assuming a normal chest film excludes all tuberculosis.
05Public health and continuity
Suspected infectious pulmonary TB needs appropriate airborne precautions and prompt linkage to the local programme. Treatment requires a complete supervised regimen guided by susceptibility and patient factors, with adherence support and toxicity monitoring. Coordinate contact evaluation through public-health services. Explain the plan respectfully and avoid stigma. For pneumonia, plan follow-up based on symptoms, risk factors and local imaging guidance, especially when recovery is incomplete.
High-Yield Revision
- Assess oxygenation and perfusion before relying on a severity score.
- Review antibiotics against response and microbiology.
- TB evaluation includes infection control and continuity of treatment.
Common Pitfalls
- Do not diagnose drug susceptibility from an X-ray.
- Do not keep extending antibiotics without reviewing the cause of poor response.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.