Pneumonia admission is not about pneumonia, refer Fig. 32.1 for general workflow. Admission criteria is based on PSI (Table 32.1) or CURB-65 (Table 32.2), but more importantly, pay attention to potential cardiac complications using “Mayo Rule” (Table 32.9). Also, use SMART-COP (Table 32.3) and Table 32.4 to predict how stable pneumonia patient would be on the floor. Refer general treatment guideline for Tables 32.5 and 32.6. Pneumonia with effusion have completely different risk profile, use RAPID score (Table 32.7) or LENT score (Table 32.9) for prognosis. For parapneumonic effusion, fluid pH and RAPID score guides treatment strategy (Table 32.8). Keep it in mind if pneumonia is due to aspiration, it has much higher mortality. And often aspiration is a telltale sign of progression of underlying condition such as dementia, Parkinson’s disease. Treatment non-responders after 72 h, refer to Table 32.11 for other considerations.