Babies and children between the ages of three months and
11-years-old with pneumonia should be offered a three-day rather
than five-day course of antibiotics, according to a new draft
NICE guideline.
The updated draft pneumonia: diagnosis and
management clinical guideline opens for public consultation
today (Wednesday, 9 April).
It recommends offering a three-day course of antibiotics for
babies and children without complications or underlying disease
who have pneumonia which is not assessed as severe and was
contracted outside of a healthcare setting.
NICE's independent guideline committee made the updated
recommendation based on evidence that showed for babies and
children up to 11 with community acquired pneumonia, a three-day
course of antibiotics was as effective as a five-day course.
The committee acknowledged that overuse of antibiotics is
associated with antimicrobial resistance and is a national and
global priority. Shorter courses of antibiotics are becoming
increasingly recognised as standard practice for many common
infections, including urinary tract infections and acute
bronchitis.
Community-acquired pneumonia (CAP) accounts for 5-12% of all
lower respiratory tract infections managed by GPs in the
community in England. Between 22% and 42% (82,242-157,008) of
people with CAP will require hospital-based care.
Professor Jonathan Benger, chief medical officer and
interim director of the Centre for Guidelines at NICE,
said: “We have made these recommendations as the
evidence shows a shorter course of treatment is just as effective
for this group, it reduces the risk of antimicrobial resistance
and saves NHS resources.
“Shorter courses of antibiotics are an important part of ensuring
medicines are not overused, which can lead to
resistance.”
The proposed recommendations also include using steroids (in
addition to antibiotics) for adults with severe
community-acquired pneumonia. The previous recommendation was not
to routinely offer a steroid treatment unless it was indicated
for other conditions.
Other changes include a recommendation for healthcare
professionals to consider an initial C-reactive protein (CRP) or
procalcitonin (PCT) blood test to help assess inflammation in the
lungs of people admitted to hospital with pneumonia. It adds that
CRP or PCT should also be considered three to four days after the
start of treatment in cases where there are concerns it might not
be working effectively.
Other new draft recommendations include that healthcare
professionals should consider a trial of high flow nasal oxygen
for people with respiratory failure where standard oxygen therapy
is insufficient.
It also recommends not routinely offering chest x-rays to people
discharged from inpatient care after an episode of pneumonia but
instead to consider a follow-up chest x-ray six weeks after
discharge if people have continuing symptoms or underlying
respiratory disease.
The updated pneumonia guidelines cover children for the first
time and combine two existing antimicrobial prescribing
guidelines covering community-acquired pneumonia
and hospital-acquired pneumonia,
which were both published in 2019.
Consultation on the proposed pneumonia: diagnosis and
management guideline update opens on Wednesday, 9 April and
will to run until Monday, 12 May with the final updated guideline
publishing later this year.
Notes to editors
