NICE finalises guidance on shorter antibiotic course in children with pneumonia
Children with uncomplicated pneumonia should be treated with shorter courses of antibiotics after updated NICE guidance was finalised.
Babies and children between three months and 11 years of age with non-severe community-acquired pneumonia should be offered a three-day course of antibiotics rather than the standard five days, NICE has now recommended.
The shorter course is advised for children who have no complications or underlying disease.
But treatment duration can be extended if they are not clinically stable, for example, if they are in respiratory distress or their oxygen saturation levels have not improved as expected, NICE said in the final document.
An antibiotic course should be stopped in all young people and children after five days unless ‘microbiological results suggest a longer course is needed or the child or young person is not clinically stable’, the recommendations stated.
The committee made the change to the 2019 guidelines after considering evidence that for babies and children up to the age of 11, a three-day course has been shown to be ‘just as effective’.
Studies looked at, including one from the UK, found no differences in adverse effects outcomes between the shorter or longer duration courses including around the frequency of re-admission for further antibiotics.
But for children under three months, the committee said it would ‘have concerns’ about a reduced duration of antibiotics.
It is also important that the diagnosis in children and young people is confirmed to be community acquired pneumonia as antibiotics may be less effective or not work at all for children with a cough or lower respiratory tract infection not caused by pneumonia, the committee added.
‘Not all community-acquired pneumonia resolves as expected, and longer courses of antibiotics may be needed in some babies and children,’ the NICE advisory committee said. ‘This should be guided by clinical judgement.’
Parents and carers should also be advised that symptoms of pneumonia can last a long time and having symptoms after stopping treatment does not mean that the drugs have not worked, the updated recommendations stated.
The new guidelines should also contribute to antimicrobial stewardship efforts, NICE added.
At the time it noted that shorter courses of antibiotics are becoming increasingly recognised as standard practice for many common infections, including urinary tract infections and acute bronchitis.
But previous advice for GPs to consider referring children and young people with community-acquired pneumonia to hospital or seek specialist paediatric advice on further investigation and management has not changed since the 2019 guidance.
Other updates to the proposed recommendations include use of steroids in addition to antibiotics for adults with severe community-acquired pneumonia being treated in hospital.
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READERS' COMMENTS [2]
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common sense surely shows that once the patient is better the antibiotics can be stopped. This assumes the patient is uncomplicated with a functioning immune system. I always assumed that the antibiotic would destroy most of the common bacteria very quickly. They split/multiply every 30 to 60 minutes so in 24 hours at least 20 genertions of them will be hit by the antibiotic and a three day course will prevent over 60 generations. At the same time our own immune system is revving up to destroy any that are left.
When I trained it was normal for those in authority to demand a 7 or even 10 day course claiming that anything shorter would cause bacterial resistance. This advice now looks to be almost the opposite of what is best. I would encourage a healthy skepticism of any medical dogma that defies common sense. Perhaps we could start by accepting that fever is an important boost to the bodies immune system and all the advice to reduce it for simple viruses is misguided or plain wrong.
I agree with Dr Heatley about fever. Why is everyone consulting with one high temperature reading? Who is to blame for this – the replacement of grandparents with nurseries (Sorry, you’ll have to pick your kid up – but we’re still charging you) and NHS 111 (The ambulance is on its way)?