“It’s just a chest infection — can I have antibiotics and carry on at home?”

Suspected COMMUNITY-ACQUIRED PNEUMONIA is a SEVERITY/DISPOSITION decision (home vs hospital), not a reflex prescription. Assess with CRB-65 — one point each for new CONFUSION, Respiratory rate ≥30/min, low Blood pressure (systolic <90 or diastolic ≤60), and age ≥65 — where higher scores indicate higher mortality risk and favour hospital assessment (NICE NG250 1.2.3: 0 usually primary care, 1 primary care with safety-netting or other community options, ≥2 consider hospital referral; in hospital CURB-65 adds Urea). CRB-65 is a guide, not the whole decision: also weigh oxygen saturations/oxygenation, respiratory rate and work of breathing, observations/NEWS, comorbidity (e.g. COPD), hydration, social support and ability to cope, and sepsis features — new confusion, hypoxia, tachypnoea, hypotension or significant comorbidity all lower the threshold to ADMIT. Recognise severe pneumonia/sepsis markers warranting admission (new confusion, RR ≥30, hypotension, low sats, age ≥65 with comorbidity, sepsis signs, inability to manage at home); an older COPD patient with new confusion and breathlessness is not a "carry on at home" case and needs face-to-face assessment of observations/sats and probable admission. Treat per severity/local guidance (antibiotics chosen by severity, antipyretics, fluids, oxygen if needed). Crucially, in an older EX-SMOKER arrange a follow-up CHEST X-RAY (~6 weeks) to confirm radiological resolution, because a non-resolving or recurrent same-site consolidation can hide an underlying LUNG CANCER (BTS 2009 and the NICE NG250 committee discussion support the ~6-week film for higher-risk people such as smokers; NICE NG12 (Suspected cancer: recognition and referral, last updated April 2026): consider an urgent CXR at 40+ with persistent or recurrent chest infection, and offer one at 40+ to an ever-smoker with an unexplained symptom such as cough, breathlessness, chest pain or weight loss) — don’t let "just a chest infection" mask a tumour. The hidden agenda is minimisation and fear of hospital; assess severity properly, make the disposition decision out loud, address the hospital fear with empathy, assess his capacity to refuse admission if he declines (new confusion; Mental Capacity Act 2005), treat new confusion with infection as a sepsis warning sign (NICE NG253), arrange the resolution safety-net, and safety-net deterioration — not collude with antibiotics-and-carry-on.