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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’.