Babies and children between three months and 11 years of age with pneumonia should be offered a three-day course of antibiotics rather than five days, NICE has recommended.
In draft guidance out for consultation, NICE said that the shorter course should be given in babies and children with non-severe community-acquired pneumonia without complications or underlying disease to cut the risk of antibiotic resistance.
A course of treatment can be extended in this group if they are not clinically stable, or their oxygen saturation levels have not improved as expected, NICE recommended in the updated guidance.
The committee said evidence showed three days was as effective as five in children with no difference in adverse outcomes including readmission.
It added that overuse of antibiotics is associated with antimicrobial resistance and is a national and global priority.
Shorter courses of antibiotics are becoming increasingly recognised as standard practice for many common infections, including urinary tract infections and acute bronchitis, NICE added.
But the committee noted they would be concerned about reducing the duration in a child under three months of age.
They also said that antibiotics are usually less effective or may be ineffective in children with a cough or lower respiratory tract infection not caused by pneumonia, so it is important that the diagnosis was correct.
It would also be important to convey to parents and carers that symptoms of pneumonia can last a long time after stopping antibiotics and this does not mean they have not worked.
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 had not changed, the draft guidelines stated.
Other updates to the proposed recommendations include use of steroids in addition to antibiotics for adults with severe community-acquired pneumonia.
And a C-reactive protein (CRP) or procalcitonin (PCT) blood test should be considered when patients are first admitted to hospital with pneumonia, NICE said.
People discharged from inpatient care after an episode of pneumonia should not routinely be offered chest X-rays but it could be considered after six weeks as a follow up if they have continuing symptoms or underlying respiratory disease.
Professor Jonathan Benger, chief medical officer and interim director of the Centre for Guidelines at NICE, said: ‘We have made these recommendations as the evidence shows a shorter course of treatment is just as effective for this group, it reduces the risk of antimicrobial resistance and saves NHS resources.
‘Shorter courses of antibiotics are an important part of ensuring medicines are not overused, which can lead to resistance.’
The consultation on Pneumonia: diagnosis and management is open until 12 May with the final updated guideline expected later this year.
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GPs need to know about this, but children and babies with acute pneumonia should be in hospital.
Presumably we need to prepare ourselves for seeing an increased number on day 4-5 of their illness, requesting courses of antibiotics be extended – and send them back or give them the Hospital’s phone number.
Meanwhile, what is the advice for patients with coughs and colds? Is it still to pester your GP until you get at least 10 days worth of antibiotics and an Xray after 2 weeks of cough, as hospitals seem to be advising at the moment?
DC I am afraid this is exactly what will happen
Guidelines are just population guidelines. Each patient is an individual with an individual presentation.
-Some need no antibiotics.
-Some need 3 days
-Some need longer
-Some need admission
Use your experience to individualise every decision.
As Captain Barbossa said …..“the (pirate’s) code is more what you’d call “guidelines” than actual rules, welcome aboard the Black Pearl”
Has anyone done an analysis of the number of follow up appointments wasted seeing patients complaining their symptoms aren’t 100% cleared by 3 days nitrofurantoin, or 5 days amox?
And what those wasted appointments are preventing us from otherwise doing?
And how does the effect of a 2-5 day shorter script compare to, say, importing AMR from agriculture or from practice overseas, where you can buy augmentin for a runny nose?