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["Baseline assessment: Pneumonia"]
["(community-acquired): antimicrobial"]
["prescribing"]
["NG138"]
[]
[]
["Published: 16 September 2019"]

{"sheet":"Introduction","index":1,"n_rows":23,"n_cols":1,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Baseline assessment tool for pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)"]
[]
["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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["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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["It should be used in conjunction with pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)."]
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["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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["Is the guideline relevant?"]
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[]
["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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["The table can be adapted to include any other local information that is thought to be useful."]
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["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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["Tools and resources to help put the guidance into practice are available on the NICE website. "]
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["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2024. All rights reserved. Subject to Notice of rights.\n"]

{"sheet":"Data sheet","index":2,"n_rows":29,"n_cols":10,"rows_kept":29,"cut":false,"hidden":false,"merged":[[0,0,0,9]]}
["Baseline assessment tool for pneumonia (community-acquired): (NICE antimicrobial prescribing guideline NG138)"]
[]
[null,null,null,"Number of relevant or partially relevant recommendations",{"$f":"COUNTIF(C8:C29,\"Yes\")","v":0}]
[null,null,null,"Number of recommendations met",{"$f":"COUNTIF(E8:E29,\"Yes\")","v":0}]
[null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(E4/E3),\"\",E4/E3)","v":""}]
[]
["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"]
["1.1   Managing community-acquired pneumonia"]
["Treatment for adults, young people and children"]
["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 table 1 [amended 2021]\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 multidrug-resistant bacteria.\n\n"]
["At the time of publication (September 2019), no validated severity assessment tools are available for children and young people with community-acquired pneumonia, and severity of symptoms or signs should be based on clinical judgement.","1.1.1"]
["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"]
["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"]
["If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.","1.1.4"]
["This recommendation has been removed.","1.1.5"]
["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"]
["Advice"]
["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\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"]
["Reassessment"]
["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"]
["When reassessing adults, young people and children with community-acquired pneumonia, be aware of possible non‑bacterial causes, such as flu.","1.1.9"]
["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"]
["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"]
["Referral and seeking specialist advice"]
["Refer adults with community-acquired pneumonia to hospital 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. [amended 2021]","1.1.12"]
["\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"]
["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"]
["1.2   Choice of antibiotic"]
["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"]

{"sheet":" Table 1","index":3,"n_rows":26,"n_cols":2,"rows_kept":26,"cut":false,"hidden":false,"merged":[]}
["Table 1 Antibiotics for adults aged 18 years and over"]
["Treatment","Antibiotic, dosage and course length"]
["First-choice oral antibiotic if low severity (based on clinical judgement and guided by a CRB65 score 0 or a CURB65 score 0 or 1 when these scores can be calculated)","Amoxicillin:\n500 mg three times a day (higher doses can be used; see the BNF) for 5 days"]
["Alternative oral antibiotics if low severity, for penicillin allergy or if amoxicillin unsuitable (for example, if atypical pathogens suspected)","Doxycycline:\n200 mg on first day, then 100 mg once a day for 4 days (5 day course in total)\nClarithromycin:\n500 mg twice a day for 5 days\nErythromycin (in pregnancy):\n500 mg four times a day for 5 days"]
["First-choice oral antibiotics if moderate severity (based on clinical judgement and guided by a CRB65 score 1 or 2, or a CURB65 score 2 when these scores can be calculated; guided by microbiological results when available)","Amoxicillin:\n500 mg three times a day (higher doses can be used; see the BNF) for 5 days\nWith (if atypical pathogens suspected)\nClarithromycin:\n500 mg twice a day for 5 days\nOr\nErythromycin (in pregnancy):\n500 mg four times a day for 5 days"]
["Alternative oral antibiotics if moderate severity, for penicillin allergy (guided by microbiological results when available)","Doxycycline:\n200 mg on first day, then 100 mg once a day for 4 days (5 day course in total)\nClarithromycin:\n500 mg twice a day for 5 days"]
["First-choice antibiotics if high severity (based on clinical judgement and guided by a CRB65 score 3 or 4, or a CURB65 score 3 to 5 when these scores can be calculated; guided by microbiological results when available)","Co-amoxiclav:\n500/125 mg three times a day orally or 1.2 g three times a day intravenously for 5 days\nWith\nClarithromycin:\n500 mg twice a day orally or intravenously for 5 days\nOr\nErythromycin (in pregnancy):\n500 mg four times a day orally for 5 days"]
["Alternative antibiotic if high severity, for penicillin allergy (guided by microbiological results when available; consult a local microbiologist if fluoroquinolone not appropriate)","Levofloxacin:\n500 mg twice a day orally or intravenously for 5 days\nSee the MHRA January 2024 advice on restrictions and precautions for using fluoroquinolone antibiotics because of the risk of disabling and potentially long-lasting or irreversible side effects."]
["See the BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, "]
["pregnancy and breastfeeding, and administering intravenous (or, where appropriate, intramuscular) antibiotics."]
["Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does "]
["not require intravenous antibiotics."]
["Review intravenous antibiotics by 48 hours and consider switching to oral antibiotics if possible."]
["Stop antibiotic treatment after 5 days unless microbiological results suggest a longer course is needed or the person is"]
["not clinically stable, for example, if they have had a fever in the past 48 hours or have more than 1 sign of clinical "]
["instability (systolic blood pressure less than 90 mmHg, heart rate more than 100/minute, respiratory rate more than "]
["24/minute, arterial oxygen saturation less than 90% or partial pressure of oxygen of more than 60 mmHg in room air)."]
["Consider adding a macrolide to amoxicillin if atypical pathogens are suspected, and review when microbiological "]
["results are available. Mycoplasma pneumoniae infection occurs in outbreaks approximately every 4 years."]
["Erythromycin is preferred if a macrolide is needed in pregnancy, for example, if there is true penicillin allergy and the "]
["benefits of antibiotic treatment outweigh the harms. See the Medicines and Healthcare products Regulatory Agency"]
["(MHRA) Public Assessment Report on the safety of macrolide antibiotics in pregnancy."]
["CRB65: confusion, respiratory rate 30/minute or more, blood pressure (systolic less than 90 mmHg or diastolic "]
["than 90 mmHg or diastolic 60 mmHg or less), age 65 or more"]
["CURB65: confusion, urea more than 7 mmol/litre, respiratory rate 30/minute or more, blood pressure (systolic less "]
["than 90 mmHg or diastolic 60 mmHg or less), age 65 or more"]

{"sheet":"Table 2","index":4,"n_rows":21,"n_cols":2,"rows_kept":21,"cut":false,"hidden":false,"merged":[]}
["Table 2 Antibiotics for children and young people under 18 years"]
["Treatment","Antibiotic, dosage and course length"]
["Children under 1 month","Refer to paediatric specialist"]
["First-choice oral antibiotic for children 1 month and over if non-severe symptoms or signs (based on clinical judgement)","Amoxicillin:\n1 month to 11 months, 125 mg three times a day for 5 days\n1 year to 4 years, 250 mg three times a day for 5 days\n5 years to 17 years, 500 mg three times a day for 5 days (higher doses can be used for all ages; see BNF for children)"]
["Alternative oral antibiotics if non-severe symptoms or signs (based on clinical judgement), for penicillin allergy or if amoxicillin unsuitable (for example, atypical pathogens suspected)","Clarithromycin:\n1 month to 11 years:\nUnder 8 kg, 7.5 mg/kg twice a day for 5 days\n8 kg to 11 kg, 62.5 mg twice a day for 5 days\n12 kg to 19 kg, 125 mg twice a day for 5 days\n20 kg to 29 kg, 187.5 mg twice a day for 5 days\n30 kg to 40 kg, 250 mg twice a day for 5 days\n12 years to 17 years:\n250 mg to 500 mg twice a day for 5 days\nErythromycin (in pregnancy):\n8 years to 17 years, 250 mg to 500 mg four times a day for 5 days\nDoxycycline:\n12 years to 17 years, 200 mg on first day, then 100 mg once a day for 4 days (5 day course in total)\n(see BNF for children for use of doxycycline in children under 12)"]
["First-choice antibiotic(s) if severe symptoms or signs (based on clinical judgement; guided by microbiological results when available)","Co-amoxiclav:\nOral doses:\n1 month to 11 months, 0.5 ml/kg of 125/31 suspension three times a day for 5 days\n1 years 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 days (or 5 ml of 250/62 suspension)\n6 years 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 days\n12 years to 17 years, 500/125 mg three times a day for 5 days\nIntravenous doses:\n1 month to 2 months, 30 mg/kg twice a day\n3 months to 17 years, 30 mg/kg three times a day (maximum 1.2 g per dose three times a day)\nWith (if atypical pathogen suspected)\nClarithromycin:\nOral doses:\n1 month to 11 years:\nUnder 8 kg, 7.5 mg/kg twice a day for 5 days\n8 kg to 11 kg, 62.5 mg twice a day for 5 days\n12 kg to 19 kg, 125 mg twice a day for 5 days\n20 kg to 29 kg, 187.5 mg twice a day for 5 days\n30 kg to 40 kg, 250 mg twice a day for 5 days\n12 years to 17 years:\n250 mg to 500 mg twice a day for 5 days"]
[null,"Intravenous doses:\n1 month to 11 years, 7.5 mg/kg twice a day (maximum 500 mg per dose)\n12 years to 17 years, 500 mg twice a day\nOr\nErythromycin (in pregnancy):\n8 years to 17 years, 250 mg to 500 mg four times a day orally for 5 days"]
["Alternative antibiotics if severe symptoms or signs (based on clinical judgement), for penicillin allergy (guided by microbiological results when available)","Consult local microbiologist"]
["See the BNF for children for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, "]
["pregnancy and breastfeeding, and administering intravenous (or, where appropriate, intramuscular) antibiotics."]
["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."]
["Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics."]
["Review intravenous antibiotics by 48 hours and consider switching to oral antibiotics if possible."]
["Stop 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 blood pressure less than 90 mmHg, heart rate more than"]
["100/minute, respiratory rate less than 24/minute, arterial oxygen saturation less than 90% or PaO2 under 60 mmHg in room air])."]
["Mycoplasma pneumoniae infection occurs in outbreaks approximately every 4 years and is more common in school-aged children."]
["Erythromycin is preferred if a macrolide is needed in pregnancy, for example, if there is true penicillin allergy and the benefits of antibiotic "]
["treatment outweigh the harms. See the Medicines and Healthcare products Regulatory Agency (MHRA) Public Assessment Report "]
["on the safety of macrolide antibiotics in pregnancy."]