The guidelines for the management of adult lower respiratory tract infections (LRTIs) were developed by a task force of the European Respiratory Society (ERS) in collaboration with the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). The guidelines are based on a systematic literature search and critical appraisal of relevant clinical evidence, which was summarized in levels of evidence and translated into graded clinical recommendations. The guidelines cover management outside and inside hospitals, including diagnosis, treatment, and prevention. Key recommendations include: - **Diagnosis**: Aspiration pneumonia should be considered in patients with swallowing difficulties and acute LRTI symptoms. Cardiac failure should be considered in older patients with orthopnoea, displaced apex beat, or a history of myocardial infarction. Pulmonary embolism should be considered in patients with a history of deep vein thrombosis, immobilization, or malignant disease. Chronic airway disease should be considered in patients with wheezing, prolonged expiration, smoking history, or allergy symptoms. - **Treatment**: Symptomatic acute cough can be treated with dextromethorphan or codeine. Antibiotic treatment is recommended for suspected or definite pneumonia, selected exacerbations of chronic obstructive pulmonary disease (COPD), patients over 75 years old with fever, cardiac failure, insulin-dependent diabetes, or serious neurological disorders. Tetracycline and amoxicillin are first-choice antibiotics, with newer macrolides as alternatives in countries with low pneumococcal resistance. Levofloxacin or moxifloxacin may be considered if clinically relevant resistance rates are present. - **Prevention**: Oral immunization with bacterial extracts is not recommended for LRTI prevention. Prophylactic antibiotic therapy is not recommended for chronic bronchitis or COPD. Influenza vaccination is recommended for high-risk groups, and pneumococcal vaccination is recommended for adults at risk from pneumococcal disease. The guidelines emphasize the importance of clinical judgment and local resistance patterns in antibiotic selection and provide detailed recommendations for different clinical scenarios.The guidelines for the management of adult lower respiratory tract infections (LRTIs) were developed by a task force of the European Respiratory Society (ERS) in collaboration with the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). The guidelines are based on a systematic literature search and critical appraisal of relevant clinical evidence, which was summarized in levels of evidence and translated into graded clinical recommendations. The guidelines cover management outside and inside hospitals, including diagnosis, treatment, and prevention. Key recommendations include: - **Diagnosis**: Aspiration pneumonia should be considered in patients with swallowing difficulties and acute LRTI symptoms. Cardiac failure should be considered in older patients with orthopnoea, displaced apex beat, or a history of myocardial infarction. Pulmonary embolism should be considered in patients with a history of deep vein thrombosis, immobilization, or malignant disease. Chronic airway disease should be considered in patients with wheezing, prolonged expiration, smoking history, or allergy symptoms. - **Treatment**: Symptomatic acute cough can be treated with dextromethorphan or codeine. Antibiotic treatment is recommended for suspected or definite pneumonia, selected exacerbations of chronic obstructive pulmonary disease (COPD), patients over 75 years old with fever, cardiac failure, insulin-dependent diabetes, or serious neurological disorders. Tetracycline and amoxicillin are first-choice antibiotics, with newer macrolides as alternatives in countries with low pneumococcal resistance. Levofloxacin or moxifloxacin may be considered if clinically relevant resistance rates are present. - **Prevention**: Oral immunization with bacterial extracts is not recommended for LRTI prevention. Prophylactic antibiotic therapy is not recommended for chronic bronchitis or COPD. Influenza vaccination is recommended for high-risk groups, and pneumococcal vaccination is recommended for adults at risk from pneumococcal disease. The guidelines emphasize the importance of clinical judgment and local resistance patterns in antibiotic selection and provide detailed recommendations for different clinical scenarios.