This guideline sets out an antimicrobial prescribing strategy for hospital‑acquired pneumonia. It does not cover ventilator‑associated pneumonia. It aims to optimise antibiotic use and reduce antibiotic resistance.

  Fluoroquinolone antibiotics: In January 2024, the MHRA published a Drug Safety Update on fluoroquinolone antibiotics. These must now only be prescribed when other commonly recommended antibiotics are inappropriate. NICE is assessing the impact of this warning on recommendations in this guideline.

 For recommendations on identifying and treating hospital-acquired bacterial pneumonia secondary to COVID-19, see our rapid guideline on managing acute COVID-19.

View 3-page visual summary
See a 3-page visual summary of the recommendations, including tables to support prescribing decisions.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • People with hospital-acquired pneumonia, their families and carers

Is this guideline up to date?

July 2022: We checked this guideline and are updating it (for more information see the surveillance decision). See the guideline in development page for progress on the update.

Guideline development process

How we develop guidelines

NICE worked with Public Health England to develop this guidance.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.