Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance

Community acquired pneumonia is a common condition that causes considerable morbidity and has a mortality rate of approximately 20% for patients admitted to hospital in the United Kingdom.1 It is diagnosed in 5-12% of adults who present to general practitioners with symptoms of lower respiratory tract infection,2 3 and 22-42% are subsequently admitted to hospital.3 4 Adherence to previous guidelines has been poor, and this variation in practice can lead to suboptimal outcomes such as increased mortality and longer stay in hospital.5 6 7 Hospital acquired pneumonia (excluding ventilator associated pneumonia) has a point prevalence of approximately 1% of hospital inpatients, is estimated to lengthen hospital admission by an average of eight days, and has a high mortality rate.8 9 This article summarises the most recent recommendations for the management of both types of pneumonia from the National Institute for Health and Care Excellence (NICE).10 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Presentation with lower respiratory tract infection Of people who present to general practitioners with symptoms of lower respiratory tract infection, only a small proportion have community acquired pneumonia. In those who do not have a clinical diagnosis of pneumonia, the decision whether to prescribe antibiotics can be difficult, with a tendency towards over-prescription. Performing a point of care C reactive protein test can help to identify patients with lower respiratory tract infections who will, and will not, benefit from antibiotics.