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[null,"Baseline assessment: Pneumonia (community-acquired): antimicrobial prescribing"]
[null,"NG138"]
[]
[]
[null,"Published: September 2019"]

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[null,"Baseline assessment tool for pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Pneumonia (community-acquired): antimicrobial prescribing.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[]
[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)"]
[]
[null,null,null,null,"Number of relevant or partially relevant recommendations",{"$f":"COUNTIF(D8:D994,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F994,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
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[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1   Managing community-acquired pneumonia"]
[null,"Treatment for adults, young people and children"]
[null,"Offer an antibiotic(s) for adults, young people and children with community-acquired pneumonia. When choosing an antibiotic (see the recommendations on choice of antibiotic) take account of:\n•\tthe severity assessment for adults, as set out in the NICE guideline on pneumonia in adults\n•\tthe severity of symptoms or signs  for children and young people, based on clinical judgement\n•\tthe risk of developing complications, for example if the person has relevant comorbidity such as severe lung disease or immunosuppression\n•\tlocal antimicrobial resistance and surveillance data (such as flu and Mycoplasma pneumoniae infection rates)\n•\trecent antibiotic use\n•\trecent microbiological results, including colonisation with multi-drug resistant bacteria.","1.1.1"]
[null,"Start antibiotic treatment as soon as possible after establishing a diagnosis of community-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this – see the NICE guideline on sepsis).","1.1.2"]
[null,"Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.","1.1.3"]
[null,"If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.","1.1.4"]
[null,"For adults with community-acquired pneumonia, follow the recommendations on microbiological tests in the NICE guideline on pneumonia.","1.1.5"]
[null,"For children and young people in hospital with community-acquired pneumonia, and severe symptoms or signs or a comorbidity, consider sending a sample (for example, sputum sample) for  microbiological testing.","1.1.6"]
[null,"Advice"]
[null,"Give advice to adults, young people and children with community-acquired pneumonia about:\n•\tpossible adverse effects of the antibiotic(s) \n•\thow long symptoms are likely to last (see also the NICE guideline on pneumonia)\n•\tseeking medical help (if the person is receiving treatment in the community) if:\n-\tsymptoms worsen rapidly or significantly, or\n-\tsymptoms do not start to improve within 3 days, or\n-\tthe person becomes systemically very unwell.","1.1.7"]
[null,"Reassessment"]
[null,"Reassess adults, young people and children with community‑acquired pneumonia if symptoms or signs do not improve as expected or worsen rapidly or significantly.","1.1.8"]
[null,"When reassessing adults, young people and children with community-acquired pneumonia, be aware of possible non‑bacterial causes, such as flu.","1.1.9"]
[null,"If a sample has been sent for microbiological testing:\n•\treview the choice of antibiotic(s) when results are available, and\n•\tconsider changing the antibiotic(s) according to results, using a narrower spectrum antibiotic, if appropriate. ","1.1.10"]
[null,"Send a sample (for example, a sputum sample) for microbiological testing if symptoms or signs have not improved following antibiotic treatment, and this has not been done already.","1.1.11"]
[null,"Referral and seeking specialist advice"]
[null,"Refer adults with community-acquired pneumonia to hospital as set out in the NICE guideline on pneumonia, or if they have:\n•\tany symptoms or signs suggesting a more serious illness or condition (for example cardiorespiratory failure or sepsis), or \n•\tsymptoms that are not improving as expected with antibiotics.","1.1.12"]
[null,"\tConsider referring adults with community-acquired pneumonia to hospital, or seek specialist advice, if they:\n•\thave bacteria that are resistant to oral antibiotics, or\n•\tcannot take oral medicines (exploring locally available options for giving intravenous antibiotics at home or in the community, rather than in hospital, if this is appropriate).","1.1.13"]
[null,"Consider referring children and young people with community-acquired pneumonia to hospital, or seek specialist paediatric advice on further investigation and management.","1.1.14"]
[null,"1.2   Choice of antibiotic"]
[null,"When prescribing an antibiotic(s) for community-acquired pneumonia:\n•\tfollow table 1 for adults aged 18 years and over\n•\tfollow table 2 for children and young people under 18 years. ","1.2.1"]

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[null,"Table 1. Antibiotics for adults aged 18 years and over"]
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[null,"Antibiotic1","Dosage and course length2"]
[null,"First choice oral antibiotic if low severity (based on clinical judgement and guided by CRB65 score 0, or CURB65 score 0 or 1)3"]
[null,"Amoxicillin ","500 mg three times a day (higher doses can be used – see BNF) for 5 days4 "]
[null,"Alternative oral antibiotics if low severity, for penicillin allergy or if amoxicillin unsuitable (for example, atypical pathogens suspected5)3"]
[null,"Doxycycline","200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)4"]
[null,"Clarithromycin","500 mg twice a day for 5 days4"]
[null,"Erythromycin (in pregnancy)","500 mg four times a day for 5 days4"]
[null,"First choice oral antibiotics if moderate severity (based on clinical judgement and guided by CRB65 score 1 or 2, or CURB65 score 2); guided by microbiological results when available3"]
[null,"Amoxicillin with (if atypical pathogens suspected5):","500 mg three times a day (higher doses can be used – see BNF) for 5 days4 "]
[null,"Clarithromycin6 or","500 mg twice a day for 5 days4"]
[null,"Erythromycin6 (in pregnancy)","500 mg four times a day for 5 days4"]
[null,"Alternative oral antibiotics if moderate severity, for penicillin allergy; guided by microbiological results when available3"]
[null,"Doxycycline","200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)4"]
[null,"Clarithromycin","500 mg twice a day for 5 days4 "]
[null,"First choice antibiotics if high severity (based on clinical judgement and guided by CRB65 score 3 or 4, or CURB65 score 3 to 5); guided by microbiological results when available3"]
[null,"Co‑amoxiclav with:","500/125 mg three times a day orally or 1.2 g three times a day IV7 for 5 days4"]
[null,"Clarithromycin or","500 mg twice a day orally or IV7 for 5 days4"]
[null,"Erythromycin (in pregnancy)","500 mg four times a day orally for 5 days4"]
[null,"Alternative antibiotic if high severity, for penicillin allergy; guided by microbiological results when available3"]
[null,"Levofloxacin8 (consider safety issues)","500 mg twice a day orally or IV7 for 5 days5"]
[null,"Consult local microbiologist if fluoroquinolone not appropriate."]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breast-feeding, and administering intravenous (or, where appropriate, intramuscular) antibiotics."]
[null,"2Oral doses are for immediate‑release medicines."]
[null,"3Give oral antibiotics first-line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. "]
[null,"4Stop antibiotic treatment after 5 days unless microbiological results suggest a longer course is needed or the person is not clinically stable (fever in past 48 hours or more than 1 sign of clinical instability [systolic BP < 90 mmHg, heart rate > 100/min, respiratory rate > 24/min, arterial oxygen saturation < 90% or PaO2 < 60 mmHg in room air])."]
[null,"5Mycoplasma pneumoniae infection occurs in outbreaks approximately every 4 years."]
[null,"6Consider adding a macrolide to amoxicillin if atypical pathogens suspected. Review when microbiological results available."]
[null,"7Review intravenous antibiotics by 48 hours and consider switching to oral antibiotics if possible."]
[null,"8See MHRA advice for restrictions and precautions for using fluoroquinolone antibiotics due to very rare reports of disabling and potentially long-lasting or irreversible side effects affecting musculoskeletal and nervous systems. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution for people over 60 years and avoiding coadministration with a corticosteroid (March 2019)."]
[null,"Abbreviations: C(U)RB65, confusion, (urea >7 mmol/l), respiratory rate ≥ 30/min, low systolic [<90 mm Hg] or diastolic [≤60 mm Hg] blood pressure, age ≥65; IV, intravenous; PaO2, partial pressure of oxygen."]
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[null,"Table 2. Antibiotics for children and young people under 18 years"]
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[null,"Antibiotic1","Dosage and course length2"]
[null,"Children under 1 month"]
[null,"Refer to paediatric specialist. "]
[null,"Children aged 1 month and over"]
[null,"First choice oral antibiotic if non-severe symptoms or signs (based on clinical judgement)3"]
[null,"Amoxicillin","1 to 11 months, 125 mg three times a day for 5 days4"]
[null,null,"1 to 4 years, 250 mg three times a day for 5 days4"]
[null,null,"5 to 17 years, 500 mg three times a day for 5 days4 (higher doses can be used for all ages – see BNF for children)"]
[null,"Alternative oral antibiotics if non-severe symptoms or signs (based on clinical judgement), for penicillin allergy or if amoxicillin unsuitable (for example, atypical pathogens suspected5)3"]
[null,"Clarithromycin","1 month to 11 years:"]
[null,null,"Under 8 kg, 7.5 mg/kg twice a day for 5 days4"]
[null,null,"8 to 11 kg, 62.5 mg twice a day for 5 days4"]
[null,null,"12 to 19 kg, 125 mg twice a day for 5 days4"]
[null,null,"20 to 29 kg, 187.5 mg twice a day for 5 days4 "]
[null,null,"30 to 40 kg, 250 mg twice a day for 5 days4"]
[null,null,"12 to 17 years:"]
[null,null,"250 mg to 500 mg twice a day for 5 days4"]
[null,"Erythromycin (in pregnancy)","8 to 17 years, 250 mg to 500 mg four times a day for 5 days4"]
[null,"Doxycycline6","12 to 17 years, 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)4"]
[null,"First choice antibiotic(s) if severe symptoms or signs (based on clinical judgement); guided by microbiological results when available3"]
[null,"Co‑amoxiclav","Oral doses:"]
[null,null,"1 to 11 months, 0.5 ml/kg of 125/31 suspension three times a day for 5 days4"]
[null,null,"1 to 5 years, 10 ml of 125/31 suspension three times a day or 0.5 ml/kg of 125/31 suspension three times a day for 5 days4, 7"]
[null,null,"6 to 11 years, 10 ml of 250/62 suspension three times a day or 0.3 ml/kg of 250/62 suspension three times a day for 5 days4"]
[null,null,"12 to 17 years, 500/125 mg three times a day for 5 days4"]
[null,null,"IV doses8:"]
[null,null,"1 to 2 months, 30 mg/kg two times a day4"]
[null,"with (if atypical pathogen suspected5):","3 months to 17 years, 30 mg/kg three times a day (maximum 1.2 g per dose three times a day)4"]
[null,"Clarithromycin or","Oral doses: see above for clarithromycin; for 5 days4"]
[null,null,"IV doses8:"]
[null,null,"1 month to 11 years, 7.5 mg/kg twice a day (maximum 500 mg per dose)4"]
[null,null,"12 to 17 years, 500 mg twice a day4"]
[null,"Erythromycin (in pregnancy)","See oral dose above for erythromycin; for 5 days4"]
[null,"Alternative antibiotics if severe symptoms or signs (based on clinical judgement), for penicillin allergy; guided by microbiological results when available3"]
[null,"Consult local microbiologist"]
[null,"1See BNF for children for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breast-feeding, and administering intravenous (or, where appropriate, intramuscular) antibiotics."]
[null,"2Oral doses are for immediate‑release medicines. The age bands apply to children of average size and, in practice, the prescriber will use the age bands in conjunction with other factors such as the severity of the condition being treated and the child’s size in relation to the average size of children of the same age."]
[null,"3Give oral antibiotics first-line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. "]
[null,"4Stop antibiotic treatment after 5 days unless microbiological results suggest a longer course length is needed or the person is not clinically stable."]
[null,"5Mycoplasma pneumoniae infection occurs in outbreaks approximately every 4 years and is more common in school-aged children."]
[null,"6See BNF for children for use of doxycycline in children under 12."]
[null,"7Or 5 ml of 250/62 suspension."]
[null,"8Review intravenous antibiotics by 48 hours and consider switching to oral antibiotics if possible."]
[null,"Abbreviations: IV, intravenous"]