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NICE backs CRP test before prescribing antibiotics for pneumonia

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Primary care clinicians should use a “simple blood test” if it is unclear whether a patient has pneumonia and needs to be treated with antibiotics, according to the National Institute for Health Care Excellence.

NICE has published its first guideline to improve treatment of people with pneumonia and reduce their risk of death.

“We need to make sure that clinicians are absolutely clear on the best way to treat people with pneumonia”

Mark Baker

It priorities the principles of antimicrobial stewardship, noting that many patients will go to their GP surgery with symptoms of a chest infection but the exact cause and severity needs to be known to determine the best treatment.

As a result, the guideline recommends the use of C-reactive protein (CRP) tests before prescribing, adding that patients may agree to wait to see if their condition worsens.

Michael Moore, professor of primary healthcare research at Southampton University and a member of the NICE guideline development group, noted that chest infections provided a “tricky problem” for clinicians.

“Patients with chesty coughs require careful assessment and thoughtful treatment,” he said. “Without the use of a chest X-ray, pneumonia can be difficult to distinguish from other common respiratory infections.

University of Southampton

Michael Moore

Professor Moore said using a CRP test, as well as checking signs and symptoms, could help the clinician “work out what’s happening”. “The CRP test can be carried out in the GP surgery and it helps decide whether or not treatment with antibiotics is needed,” he said.

He described CRP test as an “important tool” that can help reduce antibiotic prescribing while still being confident about offering patients the best treatment.

NICE highlighted that 42% of patients diagnosed with pneumonia will go to hospital and about 10% of those admitted will end up in intensive care – where they have a 30% risk of dying.

Its guidance advises how to assess the severity of illness and whether people need to be referred to hospital. The guideline calls for hospitals to have procedures in place that allow diagnosis – including X-rays – and treatment of pneumonia to take place within four hours of admission.

The guideline also recommends that those with low severity pneumonia should be offered a shorter five-day course of a single antibiotic instead of the standard seven-day course.

Professor Mark Baker, NICE’s director of clinical practice, said: “We need to make sure that clinicians are absolutely clear on the best way to treat people with pneumonia, whether that’s in hospital or in the community and this guideline provides that.”

Mark Baker

Mark Baker

The guideline also includes useful information that should be given to patients recovering from pneumonia to help reduce anxiety and also avoid unnecessary repeat appointments.

For example, letting them know that symptoms should steadily improve after starting treatment but it may take up to six months to feel back to normal.

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