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Covid-19 Primary Care Resources


Differentiating viral Covid-19 pneumonia from bacterial pneumonia



It is difficult to determine whether pneumonia has a Covid‑19 viral cause or a bacterial cause

This information is sourced from NICE:

It is difficult to determine whether pneumonia has a Covid‑19 viral cause or a bacterial cause (either primary or secondary to Covid‑19) in primary care, particularly during remote consultations.

However, as Covid‑19 becomes more prevalent in the community, patients presenting with pneumonia symptoms are more likely to have a Covid‑19 viral pneumonia than a community-acquired bacterial pneumonia.

COVID‑19 viral pneumonia may be more likely if the patient:

  • presents with a history of typical Covid symptoms for about a week
  • has severe muscle pain (myalgia)
  • has loss of sense of smell (anosmia)
  • is breathless but has no pleuritic pain
  • has a history of exposure to known or suspected COVID‑19, such as a household or workplace contact

Bacterial cause of pneumonia may be more likely if the patient:

  • becomes rapidly unwell after only a few days of symptoms
  • does not have a history of typical Covid‑19 symptoms
  • has pleuritic pain
  • has purulent sputum

Treatment:

Do not offer an antibiotic for treatment or prevention of pneumonia if Covid‑19 is likely to be the cause and symptoms are mild

Offer an oral antibiotic for treatment of pneumonia in people who can or wish to be treated in the community if:

  • the likely cause is bacterial
  • it is unclear whether the cause is bacterial or viral and symptoms are more concerning
  • they are at high risk of complications because, for example, they are older or frail, or have a pre-existing comorbidity such as immunosuppression or significant heart or lung disease (for example bronchiectasis or COPD), or have a history of severe illness following previous lung infection

When starting antibiotic treatment, the first-choice oral antibiotic is:

For choice of antibiotics in penicillin allergy, pregnancy and more severe disease, or if atypical pathogens are likely, see the recommendations on choice of antibiotic in the NICE antimicrobial prescribing guideline on community-acquired pneumonia.