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GPs should use point-of-care test to guide antibiotic use for pneumonia, says NICE



GPs should consider using a point-of-care test to help decide whether patients presenting with mild pneumonia need antibiotics, according to draft recommendations from NICE.

The draft guidance proposes GPs carry out the test – for C-reactive protein levels – if it is not clear from a clinical assessment whether antibiotics should be prescribed (see box).

They should then offer a five-day course of a single antibiotic in patients with low-severity pneumonia – but not a fluoroquinolone – and tell patients to come back if their symptoms do not improve within three days.

The guidance also advises GPs to use the CRB65 risk score when making a judgement about whether patients should be referred to hospital.

The CRB65 score assigns points based on aspects such as confusion, raised respiratory rate, low blood pressure and older age. NICE says GPs can consider home-based care for patients with a score of zero, but should consider hospital assessment for all other patients, particularly those with a score of two or higher.

Professor Mark Baker, NICE’s director of clinical practices, said: ‘Pneumonia can be difficult to treat; it requires careful assessment and thoughtful treatment. These new draft recommendations make it very clear how to best test for pneumonia and when to consider treating with antibiotics.’

NICE draft pneumonia guidance – C-reactive protein test

Consider a point-of-care C-reactive protein (CRP) test for patients with lower respiratory tract infection in primary care if it is not clear after clinical assessment whether antibiotics should be prescribed. Use the results of the CRP test as follows:

  • Do not routinely offer antibiotic therapy if the C-reactive protein concentration is less than 20mg/litre
  • Consider a delayed antibiotic prescription (a prescription for use at a later date if symptoms worsen) if the C-reactive protein concentration is between 20 mg/litre and 100 mg/litre
  • Offer antibiotic therapy if the C-reactive protein concentration is greater than 100 mg/litre

This story was amended 22.40, 18 June to clarify when GPs should consider home care or hospital assessment based on the CRB65 risk score.

NICE draft guidelines – Pneumonia: diagnosis and management of community- and hospital-acquired pneumonia in adults