Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidanceBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6722 (Published 03 December 2014) Cite this as: BMJ 2014;349:g6722
- Sinan Eccles, specialist trainee in respiratory medicine1,
- Celia Pincus, project manager2,
- Bernard Higgins, National Clinical Guideline Centre clinical director and respiratory physician23,
- Mark Woodhead, guideline chair and honorary clinical professor of respiratory medicine4
- on behalf of the Guideline Development Group
- 1Royal Gwent Hospital, Newport NP20 2UB, UK
- 2Royal College of Physicians, National Clinical Guideline Centre, London NW1 4LE, UK
- 3Freeman Hospital, Newcastle NE7 7DN, UK
- 4Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre and Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Correspondence to: C Pincus
Community acquired pneumonia is a common condition that causes considerable morbidity and has a mortality rate of approximately 20% for patients admitted to hospital in the United Kingdom.1 It is diagnosed in 5-12% of adults who present to general practitioners with symptoms of lower respiratory tract infection,2 3 and 22-42% are subsequently admitted to hospital.3 4 Adherence to previous guidelines has been poor, and this variation in practice can lead to suboptimal outcomes such as increased mortality and longer stay in hospital.5 6 7 Hospital acquired pneumonia (excluding ventilator associated pneumonia) has a point prevalence of approximately 1% of hospital inpatients, is estimated to lengthen hospital admission by an average of eight days, and has a high mortality rate.8 9 This article summarises the most recent recommendations for the management of both types of pneumonia from the National Institute for Health and Care Excellence (NICE).10
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.
Presentation with lower respiratory tract infection
Of people who present to general practitioners with symptoms of lower respiratory tract infection, only a small proportion have community acquired pneumonia. In those who do not have a clinical diagnosis of pneumonia, the decision whether to prescribe antibiotics can be difficult, with a tendency towards over-prescription. Performing a point of care C reactive protein test can help to identify patients with lower respiratory tract infections who will, and will not, benefit from antibiotics.
For people presenting with symptoms of lower respiratory tract infection in primary care, consider a point of care C reactive protein test if after clinical …