New antimicrobial guidance for community acquired pneumonia
NICE and Public Health England have published new antimicrobial prescribing guidance on community-acquired pneumonia (CAP).
The key recommendations are:
- Antibiotic treatment should be started as soon as possible (no more than 4 hours after diagnosis and 1 hour if sepsis is suspected).
- The choice of antibiotic should be linked to the severity of the pneumonia and be determined by the CRB65 score (confusion, respiratory rate, blood pressure, age >65)
- Initial prescription of antibiotics should be for a 5 day course but there should be a review after 3 days if there is no improvement in symptoms.
- NICE urges caution about the use of fluoroquinolones (especially levofloxacin) in view of the risk of severe tendinopathy.
The guidance stresses that the shortest antibiotic course effective should be prescribed where possible. Between 2013 and 2017, drug resistant infections in people increased by 35% in England. Earlier this year, NICE reviewed evidence that found that people, on average, are being prescribed unnecessarily long courses of antibiotics which may lead to antibiotic resistance.
Dr Helen Ashdown, GP and PCRS infection lead says: “Appropriate antibiotic use is all about getting the balance right. As primary care clinicians we have an important role in helping reduce antibiotic resistance by only using antibiotics when necessary and for the shortest duration possible. But we also need to get them quickly to the people who do need them, and that means being able to recognise the features of severe community acquired pneumonia and sepsis so that treatment can be started promptly.”