Updated guidelines for babies and children with non-serious pneumonia

9 Apr 2025 12:52 PM

Babies and children between the ages of three months and 11-years-old with pneumonia should be offered a three-day rather than five-day course of antibiotics, according to a new draft NICE guideline.

The updated draft pneumonia: diagnosis and management clinical guideline opens for public consultation today (Wednesday, 9 April).

It recommends offering a three-day course of antibiotics for babies and children without complications or underlying disease who have pneumonia which is not assessed as severe and was contracted outside of a healthcare setting.

NICE’s independent guideline committee made the updated recommendation based on evidence that showed for babies and children up to 11 with community acquired pneumonia, a three-day course of antibiotics was as effective as a five-day course.

The committee acknowledged that overuse of antibiotics is associated with antimicrobial resistance and is a national and global priority. Shorter courses of antibiotics are becoming increasingly recognised as standard practice for many common infections, including urinary tract infections and acute bronchitis

Community-acquired pneumonia (CAP) accounts for 5-12% of all lower respiratory tract infections managed by GPs in the community in England. Between 22% and 42% (82,242-157,008) of people with CAP will require hospital-based care.

We have made these recommendations as the evidence shows a shorter course of treatment is just as effective for this group, it reduces the risk of antimicrobial resistance and saves NHS resources.

Professor Jonathan Benger, chief medical officer and interim director of the Centre for Guidelines at NICE

Jonathan continued: “Shorter courses of antibiotics are an important part of ensuring medicines are not overused, which can lead to resistance.”

The proposed recommendations also include using steroids (in addition to antibiotics) for adults with severe community-acquired pneumonia. The previous recommendation was not to routinely offer a steroid treatment unless it was indicated for other conditions.

Other changes include a recommendation for healthcare professionals to consider an initial C-reactive protein (CRP) or procalcitonin (PCT) blood test to help assess inflammation in the lungs of people admitted to hospital with pneumonia. It adds that CRP or PCT should also be considered three to four days after the start of treatment in cases where there are concerns it might not be working effectively.

Other new draft recommendations include that healthcare professionals should consider a trial of high flow nasal oxygen for people with respiratory failure where standard oxygen therapy is insufficient.

It also recommends not routinely offering chest x-rays to people discharged from inpatient care after an episode of pneumonia but instead to consider a follow-up chest x-ray six weeks after discharge if people have continuing symptoms or underlying respiratory disease.

The updated pneumonia guidelines cover children for the first time and combine two existing antimicrobial prescribing guidelines covering community-acquired pneumonia and hospital-acquired pneumonia, which were both published in 2019.

Consultation on the proposed pneumonia: diagnosis and management guideline update opens on Wednesday, 9 April and will to run until Monday, 12 May with the final updated guideline publishing later this year.