what is the first line antibiotics for management of LRTI for adults

The provided UK guidelines focus on the assessment and management of lower respiratory tract infections (LRTIs) and community-acquired pneumonia in adults, including when to consider antibiotic prescribing, but they do not specify the first-line antibiotic choices ¹,².

For individuals with suspected acute respiratory infection, clinical assessment is used to determine whether to prescribe antimicrobials, either immediately or with a back-up prescription ¹. A point-of-care C-reactive protein (CRP) test can support clinical decision-making if it is unclear whether antibiotics are needed ¹. Immediate antibiotics may be offered if the CRP level is more than 100 mg/litre, while a back-up antibiotic prescription may be considered if the CRP level is between 20 mg/litre and 100 mg/litre ¹. Antibiotics are not routinely offered if the CRP level is less than 20 mg/litre ¹.

If a clinical diagnosis of pneumonia is made, a risk assessment using the CRB65 scoring system should be carried out ¹,². The CRB65 score helps inform decisions about whether hospital assessment is needed, with a score of 0 suggesting home-based care, a score of 1 prompting discussion for shared decision-making on care pathways, and a score of 2 or more indicating consideration for hospital assessment ¹,². The guidelines refer to other NICE guidance for further details on the diagnosis and management of pneumonia and antimicrobial prescribing for community-acquired pneumonia ¹.