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[null,"Baseline assessment: Pneumonia (hospital acquired): antimicrobial prescribing"]
[null,"NG139"]
[]
[]
[null,"Published: September 2019"]

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[null,"Baseline assessment tool for pneumonia (hospital acquired): (NICE antimicrobial prescribing guideline NG139)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Pneumonia (hospital 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 (hospital acquired): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG139)."]
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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 (hospital acquired): (NICE antimicrobial prescribing guideline NG139)"]
[]
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[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F995,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
[]
[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 hospital‑acquired pneumonia"]
[null,"Treatment for adults, young people and children"]
[null,"For adults, young people and children with symptoms or signs of pneumonia starting within 48 hours of hospital admission, follow the NICE guideline on community‑acquired pneumonia.","1.1.1"]
[null,"Offer an antibiotic(s) for adults, young people and children with hospital acquired pneumonia. When choosing an antibiotic(s), (see the recommendations on choice of antibiotic) take account of:\n•\tthe severity of symptoms or signs  \n•\tthe number of days in hospital before onset of symptoms \n•\tthe risk of developing complications, for example if the person has a relevant comorbidity such as severe lung disease or immunosuppression\n•\tlocal hospital and ward-based antimicrobial resistance data\n•\trecent antibiotic use \n•\trecent microbiological results, including colonisation with multi drug resistant bacteria\n•\trecent contact with a health or social care setting before current admission\n•\tthe risk of adverse effects with broad spectrum antibiotics, such as Clostridium difficile infection.","1.1.2"]
[null,"Start antibiotic treatment as soon as possible after establishing a diagnosis of hospital‑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).","1.1.3"]
[null,"Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.","1.1.4"]
[null,"If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.","1.1.5"]
[null,"Send a sample (for example, sputum sample, nasopharyngeal swab or tracheal aspirate) for microbiological testing.","1.1.6"]
[null,"Reassessment and specialist advice"]
[null,"When microbiological results are available:\n•\treview the choice of antibiotic(s), and\n•\tchange the antibiotic(s) according to results, using a narrower spectrum antibiotic, if appropriate. ","1.1.7"]
[null,"Reassess adults, young people and children with hospital acquired pneumonia if symptoms do not improve as expected or worsen rapidly or significantly.","1.1.8"]
[null,"Seek specialist advice from a microbiologist for adults, young people and children with hospital acquired pneumonia if they have:\n•\tsymptoms that are not improving as expected with antibiotics, or\n•\tmulti drug resistant bacteria.","1.1.9"]
[null,"Follow the NICE guideline on care of dying adults in the last days of life when caring for adults with hospital acquired pneumonia who are approaching their end of life. ","1.1.10"]
[null,"1.2  Choice of antibiotic "]
[null,"When prescribing an antibiotic(s) for hospital 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"]
[null,"Consider following the NICE guideline on community‑acquired pneumonia  for choice of antibiotic for adults, young people and children with symptoms or signs of pneumonia starting within days 3 to 5 of hospital admission who are not at higher risk of resistance.","1.2.2"]

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[null,"Table 1. Antibiotics for adults aged 18 years and over"]
[]
[null,"Antibiotic1","Dosage and course length2"]
[null,"First choice oral antibiotic for non‑severe symptoms or signs and not at higher risk of resistance3 (guided by microbiological results when available)"]
[null,"Co-amoxiclav","500/125 mg three times a day for 5 days then review4"]
[null,"Alternative oral antibiotics for non‑severe symptoms or signs and not at higher risk of resistance3, if penicillin allergy or if co‑amoxiclav unsuitable "]
[null,"Antibiotic choice should be based on specialist microbiological advice and local resistance data. Options include:"]
[null,"Doxycycline","200 mg on first day, then 100 mg once a day for 4 days (5-day course) then review4"]
[null,"Cefalexin (caution in penicillin allergy)","500 mg twice or three times a day (can be increased to 1 to 1.5 g three or four times a day) for 5 days then review4"]
[null,"Co-trimoxazole5,6","960 mg twice a day for 5 days then review4"]
[null,"Levofloxacin6 (only if switching from IV levofloxacin with specialist advice; consider safety issues7)","500 mg once or twice a day for 5 days then review4"]
[null,"First choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance3. Review IV antibiotics by 48 hours and consider switching to oral antibiotics as above for a total of 5 days then review4"]
[null,"Antibiotic choice should be based on specialist microbiological advice and local resistance data. Options include:"]
[null,"Piperacillin with tazobactam","4.5 g three times a day (increased to 4.5 g four times a day if severe infection)"]
[null,"Ceftazidime","2 g three times a day"]
[null,"Ceftriaxone","2 g once a day"]
[null,"Cefuroxime","750 mg three or four times a day (increased to 1.5 g three or four times a day if severe infection)"]
[null,"Meropenem ","0.5 to 1 g three times a day"]
[null,"Ceftazidime with avibactam","2/0.5 g three times a day"]
[null,"Levofloxacin6 (consider safety issues7)","500 mg once or twice a day (use higher dosage if severe infection)"]
[]
[null,"Antibiotics to be added if suspected or confirmed MRSA infection (dual therapy with an IV antibiotic listed above)"]
[null,"Vancomycin5,8","15 to 20 mg/kg two or three times a day IV, adjusted according to serum vancomycin concentration (a loading dose of 25 to 30 mg/kg can be used in seriously ill people). Maximum 2 g per dose"]
[null,"Teicoplanin5,8","Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once a day"]
[null,"Linezolid5 (if vancomycin cannot be used; specialist advice only)","600 mg twice a day orally or IV"]
[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,"3Higher risk of resistance includes symptoms or signs starting more than 5 days after hospital admission, relevant comorbidity such as severe lung disease or immunosuppression, recent use of broad spectrum antibiotics, colonisation with multi-drug resistant bacteria, and recent contact with a health or social care setting before current admission."]
[null,"4Review treatment after a total of 5 days of antibiotics and consider stopping antibiotics if clinically stable."]
[null,"5See BNF for information on monitoring of patient parameters."]
[null,"6Not licensed for hospital-acquired pneumonia, so use would be off label. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council’s Good practice in prescribing and managing medicines and devices for further information."]
[null,"7See 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,"8See BNF for information on therapeutic drug monitoring."]
[null,"Abbreviations: IV, Intravenous; MRSA, Meticillin‑resistant Staphylococcus aureus "]
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[null,"Table 2. Antibiotics for children and young people under 18 years "]
[]
[null,"Antibiotic1","Dosage and course length2"]
[null,"Children under 1 month"]
[null,"Antibiotic choice based on local resistance data and specialist microbiological advice"]
[null,"Children aged 1 month and over"]
[null,"First choice oral antibiotic if non‑severe symptoms or signs and not at higher risk of resistance3 (guided by microbiological results when available)"]
[null,"Co-amoxiclav","1 to 11 months, 0.5 ml/kg of 125/31 suspension three times a day for 5 days then review4"]
[null,null,"1 to 5 years, 10 ml of 125/31 suspension5 three times a day or 0.5 ml/kg of 125/31 suspension three times a day for 5 days then review4"]
[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 days then review4"]
[null,null,"12 to 17 years, 500/125 mg three times a day for 5 days then review4"]
[null,"Alternative oral antibiotic if non‑severe symptoms or signs and not at higher risk of resistance3, for penicillin allergy or if co‑amoxiclav unsuitable "]
[null,"Clarithromycin","1 month to 11 years:"]
[null,null,"Under 8 kg, 7.5 mg/kg twice a day for 5 days then review4"]
[null,null,"8 to 11 kg, 62.5 mg twice a day for 5 days then review4"]
[null,null,"12 to 19 kg, 125 mg twice a day for 5 days then review4"]
[null,null,"20 to 29 kg, 187.5 mg twice a day for 5 days then review4"]
[null,null,"30 to 40 kg, 250 mg twice a day for 5 days then review4"]
[null,null,"12 to 17 years, 500 mg twice a day for 5 days then review4"]
[null,"Other options may be suitable based on specialist microbiological advice and local resistance data."]
[null,"First choice intravenous antibiotics if severe symptoms or signs (for example, symptoms or signs of sepsis) or at higher risk of resistance3. Review IV antibiotics by 48 hours and consider switching to oral antibiotics as above for a total of 5 days then review4"]
[null,"Antibiotic choice should be based on specialist microbiological advice and local resistance data. Options include:"]
[null,"Piperacillin with tazobactam","1 month to 11 years, 90 mg/kg three or four times a day (maximum 4.5 g per dose four times a day)"]
[null,null,"12 to 17 years, 4.5 g three times a day (increased to 4.5 g four times a day if severe infection)"]
[null,"Ceftazidime","1 month to 17 years, 25 mg/kg three times a day (50 mg/kg three times a day if severe infection; maximum 6 g per day)"]
[null,"Ceftriaxone","1 month to 11 years (up to 50 kg), 50 to 80 mg/kg once a day (use dose at higher end of range if severe infection; maximum 4 g per day)"]
[null,null,"9 to 11 years (50 kg and above), 2 g once a day"]
[null,null,"12 to 17 years, 2 g once a day"]
[null,"Antibiotics to be added if suspected or confirmed MRSA infection (dual therapy with the IV antibiotic chosen from the list above)"]
[null,"Teicoplanin6,7","1 month, initially 16 mg/kg for 1 dose, then 8 mg/kg once daily, subsequent dose to be given 24 hours after initial dose (doses given by IV infusion)"]
[null,null,"2 months to 11 years, initially 10 mg/kg every 12 hours IV for 3 doses, then 6 to 10 mg/kg once daily IV"]
[null,null,"12 to 17 years, initially 6 mg/kg every 12 hours IV for 3 doses, then 6 mg/kg once daily IV"]
[null,"Vancomycin6,7","1 month to 11 years, 10 to 15 mg/kg four times a day IV, adjusted according to serum-vancomycin concentration"]
[null,null,"12 to 17 years, 15 to 20 mg/kg two or three times a day IV, adjusted according to serum-vancomycin concentration (a loading dose of 25 to 30 mg/kg can be used in seriously ill people). Maximum 2 g per dose"]
[null,"Linezolid6,8 (if vancomycin cannot be used; specialist advice only)","3 months to 11 years, 10 mg/kg three times a day orally or IV (maximum 600 mg per dose)"]
[null,null,"12 to 17 years, 600 mg twice a day orally or IV"]
[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,"3Higher risk of resistance includes symptoms or signs starting more than 5 days after hospital admission, relevant comorbidity such as severe lung disease or immunosuppression, recent use of broad spectrum antibiotics, colonisation with multi-drug resistant bacteria, and recent contact with a health or social care setting before current admission."]
[null,"4Review treatment after a total of 5 days of antibiotics and consider stopping antibiotics if clinically stable."]
[null,"5Or 5 ml of 250/62 suspension."]
[null,"6See BNF for children for information on monitoring of patient parameters."]
[null,"7See BNF for children for information on therapeutic drug monitoring."]
[null,"8Not licensed in children and young people under 18 years, so use would be off label. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information."]
[null,"Abbreviations: IV, Intravenous; MRSA, Meticillin‑resistant Staphylococcus aureus"]