Babies and children aged between three months and 11-years-old with pneumonia should be offered a three-day rather than five-day course of antibiotics, suggest new draft NICE guidelines.
The updated recommendations advise a three-day course of antibiotics for babies and children without complications or underlying disease who have pneumonia that is not assessed as severe and was contracted outside 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 was as effective as a five-day course.
The committee acknowledged that overuse of antibiotics is associated with antimicrobial resistance. Shorter courses of the medications 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.
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 update opened last week and will to run until 12 May with the final updated guideline publishing later this year.
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Short-course of antibiotics suffices for children with pneumonia
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