The draft guideline calls on GPs to assess the severity of community-acquired pneumonia in primary care using the CRB65 score, which predicts risk of death using risk factors such as age, level of confusion and BP. Moderate and severe cases should be considered for referral for hospital assessment.
It also advocates point-of-care CRP testing to decide whether antibiotic treatment is required in patients with lower respiratory tract infection where it is not clear whether antibiotics should be prescribed. The approach aims to avoid overuse of antibiotics, which contributes to antimicrobial resistance.
Each year, over 600,000 UK adults develop pneumonia. Around 42% of those diagnosed by their GP end up in hospital. One in 10 of these patients are admitted to intensive care, where they face a 30% risk of dying.
GPs should advise home-based care to patients with a CRB65 score of 0, and consider referring to hospital anyone with a score of 1 or more, particularly those with scores of 2 or more.
NICE said GPs should consider a five-day course of a single antibiotic for those with low-severity pneumonia. Amoxicillin is recommended over macrolides or tetracyclines, although the latter two can be considered for patients who are allergic to penicillin.
'Very common and can be fatal'
Treatment can be extended if symptoms persist and do not improve within three days, and patients should be advised to seek medical advice if this occurs. Patients with pneumonia should not routinely be offered a fluoroquinolone or dual antibiotic therapy.
Professor Mark Baker, NICE’s director of clinical practice, said: ‘Pneumonia is very common and can be fatal if it is not treated properly. We need to make sure that physicians are absolutely clear on the best way to treat people with pneumonia, whether that’s in hospital or in the community.'
Around 5% to 12% of patients who visit their GP with lower respiratory tract symptoms are diagnosed with pneumonia.
A study published last month had said testing CRP levels in patients with lower respiratory tract infections could help to reduce inappropriate antibiotic prescribing.
NICE expects to publish a final version of the guideline in December.