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Start antibiotics within four hours of diagnosing community-acquired pneumonia, urges NICE

GPs should start patients on antibiotics within four hours of diagnosing community-acquired pneumonia, new guidance from NICE has urged.

The guidance also emphasised that antibiotics should be started within an hour if sepsis is suspected.

NICE has published a guideline on community-acquired and hospital-acquired pneumonia antimicrobial prescribing to update recommendations made in its 2014 guidance on diagnosing and managing pneumonia. 

According to the new guidance, patients with community-acquired pneumonia should be started on antibiotics within four hours of the diagnosis being made, with the severity of the infection informing the choice of antibiotic.

NICE recommends amoxicillin first line for low-severity infection, or doxycycline if the patient has a penicillin allergy. The guideline also recommends:

  • Amoxicillin with clarithromycin, or erythromycin if the patient is pregnant, in patients with moderately severe infection.
  • Co-amoxiclav with clarithromycin, or erythromycin if the patient is pregnant, in patients with high-severity infection.
  • Levofloxacin for patients with high-severity infection and amoxicillin allergy.

The guideline stresses that safety issues should be considered when prescribing levofloxacin due to the MHRA warning of rare reports of disabling musculoskeletal and neurological side effects in patients on the drug.

The Government announced its target to cut antibiotic prescriptions by 15% earlier this year, as part of a new plan to control antimicrobial resistance by 2040. 

Research published in the BMJ in February found that 80% of prescriptions for respiratory conditions were for longer than guidelines recommended. GPs responded that balancing the need to reduce prescribing rates against situations where antibiotics could mean life or death for the patient was ‘extremely challenging’.

Readers' comments (8)

  • David Banner

    So if CAP is diagnosed OOH (with no local 24 hr pharmacy open) do we send them all to A&E?

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  • Within 4h now. I think most GPs would give it at consultation, there's no need for the guidance.
    Start antibiotics one day and complaining GPs are over prescribing the next.
    Just like the Brexit hokey cokey.
    We will see another guidance or study like this next. Start antibiotics within 10min?

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  • the guidance says to start within 4 hours once a diagnosis has been made but also if you suspect sepsis to refer to hospital immediately, the quideline also is for hospitals to start treatment asap as a way to prevent sepsis. its not a criticism of primary care. This title of this report by pulse is grossly misleading.

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  • Means GPs will need antibiotics in their bags and surgeries

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  • Sort of depends on the patients really.
    I often see patients with respiratory infections as "emergencies" to later discover they never collected their prescriptions for 48 hours!

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  • DrRubbishBin

    Once they've seen you (if they need antibiotics) they have a prescription immediately. Any delay would be down to patient and/or pharmacy factors. I guess we can tell them - "go get these straight away, don't wait until tomorrow". Unless of cause your doing an extended hours surgery, the closest pharmacy is closed and the poor patient ives on their own, doesn't drive a car and is feeling awful (on account of their community acquired pneumonia) What would the lawyers make of that one? GP negligent through failure to send to a&e? Does the NHS fund a 24 hour pharmacy taxi service? Do we need to keep a stock of appropriate antibiotics in case they can't get to a pharmacy? The unknowns in general practice are forever lurking, behind every consultation hides the possibility of an unfortunate stacking of unlikely simultaneous bad luck events the guidance didn't cover

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  • Vinci Ho

    You see
    One has to be sensible in looking at the meaning of this guidance. It is all about what to do AFTER the diagnosis of CAP is made . And I think that is then quite reasonable abs logical.
    The problem still lies BEFORE the diagnosis was reached in primary care which could be very tricky in general practice( like many other serious , life-threatening conditions in their early clinical stage) . CURB is not completely CURB because GPs cannot get urea( and also white cell count and serum CRP) right away , for instance. That is the part of any guidance( written by academics) which seems to be disappointing in appreciating how difficult our job is in the frontline .

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  • Vinci Ho

    Correction
    ....reasonable and logical ....

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