NICE has issued new draft guidance on antimicrobial prescribing for community-acquired pneumonia.
For low-severity community-acquired infection, amoxicillin 500 mg 3 times daily is the first-line treatment of choice. Clarithromycin (500 mg twice daily orally or intravenous for 5 days), erythromycin (500 mg orally 4 times daily for 5 days) and doxycycline (200 mg on day 1, 100 mg once daily orally for 5 days) can be used as alternatives where necessary.
For moderate-severe pneumonia, recommended treatment is amoxicillin, with clarithromycin or erythromycin, if suspected atypical. Recommended alternatives are clarithromycin and azithromycin.
First-choice antibiotics for high-severity community-acquired pneumonia are co-amoxiclav with clarithromycin and erythromycin, as above. Levofloxacin is recommended as an alternative in patients with penicillin allergy.
In children aged 3 months and older, first-line treatment for non-severe pneumonia should be amoxicillin. In cases of penicillin allergy or if amoxicillin is unsuitable, the recommended alternatives are clarithromycin, erythromycin and doxycycline. The guidelines include recommendations on appropriate dosages.
For severe infection in children in this age group, co-amoxiclav is the first-line antibiotic of choice and can be combined with clarithromycin or erythromycin in cases of suspected atypical pneumonia.
The complete draft guidance is available here.
Feedback on the guidelines is invited before 11 March 2019 at 5 pm. The final version of the guidelines is expected to be published in July.
Separate guidance has been issued on prescribing for hospital-acquired pneumonia.