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Guideline review
NICE community-acquired pneumonia guideline review
  1. Sarah Murphy1,
  2. Louise Thomson2
  1. 1 Department of Paediatrics, Mercy University Hospital, Cork, Ireland
  2. 2 Department of Respiratory, Royal Hospital for Children, Glasgow, UK
  1. Correspondence to Dr Sarah Murphy, Department of Paediatrics, Mercy University Hospital, Cork, Ireland; murphysarah19{at}yahoo.com

https://doi.org/10.1136/archdischild-2020-319376

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    Introduction

    Globally, pneumonia is responsible for significant morbidity and mortality in children. The incidence of community-acquired pneumonia (CAP) in Europe is estimated to be approximately 33 per 10 000 in those under 5 years of age and 14.5 per 10 000 in those aged 0–16 years.1

    In 2019, the National Institute for Health and Care Excellence (NICE) published a guideline on prescribing antibiotics for CAP in adults and children.2 The purpose of the guidance was to optimise antibiotic use and decrease antibiotic resistance. It does not address the management of hospital-acquired pneumonia. This review concentrates on the relevant paediatric advice.

    Related guidelines

    Other relevant guidelines include: ‘Fever in under 5s: assessment and initial management’ (NICE 2019, NG143), Self-limiting respiratory tract and ear infections—antibiotic prescribing overview (NICE January 2020) and Cough (acute): antimicrobial prescribing NICE guideline (NG120) (February 2019) (box 1).

    Box 1

    Relevant guidelines

    • https://www.nice.org.uk/guidance/ng120

    • https://pathways.nice.org.uk/pathways/self-limiting-respiratory-tract-and-ear-infections-antibiotic-prescribing

    • https://www.nice.org.uk/guidance/ng143

    Key issues this guideline addresses

    1. General prescribing strategies.

    2. Which antibiotics to prescribe.

    3. Dosing, course length and route of administration.

    General prescribing strategies

    • Start antibiotic treatment as soon as possible and within 4 hours (1 hour if suspected sepsis).

    • Give oral antibiotics as first line unless the child is unable to tolerate them or has increased severity of illness.

    • If intravenous antibiotics have been prescribed, the need for continued intravenous treatment should generally be reviewed by 48 hours.

    Factors to consider

    • Severity of symptoms or signs.

    • Risk of complications (eg, comorbidity—severe lung disease/immunosuppression).

    • Local antimicrobial resistance and surveillance data (eg, influenza/mycoplasma …

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    Footnotes

    • Contributors SM and LT contributed equally to the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.