BTS Guideline recommendations that overlap with NICE Guideline recommendations where major differences exist
| BTS recommendation (number) [grade*] | Related NICE recommendation (number) | Main difference |
|---|---|---|
| (27) Investigations for legionella pneumonia are recommended for all patients with high severity CAP, for other patients with specific risk factors and for all patients with CAP during outbreaks. [D] | (1.2.7) For patients with moderate- or high-severity community-acquired pneumonia: take blood and sputum cultures and consider pneumococcal and legionella urinary antigen tests. | Patient groups for legionella testing NICE recommends consideration of legionella urinary antigen tests for patients with both moderate and high severity CAP, not just high severity CAP. NICE did not examine the value of legionella urinary antigen tests in patients with specific risk factors or in outbreak situations; the BTS recommendations in relation to these situations remain valid. |
| (28) Legionella urine antigen tests should be performed for all patients with high severity CAP. [B+] | ||
| (59) Review of patients in the community with CAP is recommended after 48 h or earlier, if clinically indicated. Disease severity assessment should form part of the clinical review. [D] | (1.2.13) Explain to patients with low-severity community-acquired pneumonia treated in the community, and, when appropriate, their families or carers, that they should seek further medical advice if their symptoms do not begin to improve within 3 days of starting the antibiotic, or earlier if their symptoms are worsening. (1.2.23) Advise patients with community-acquired pneumonia to consult their healthcare professional if they feel that their condition is deteriorating or not improving as expected. | Timing of review NICE recommendations are framed in the context of an outer limit (within 3 days), not a lower limit (after 48 h). |
| (60) Those who fail to improve after 48 h of treatment should be considered for hospital admission or chest radiography. [D] | ||
| (106) For patients managed in the community and for most patients admitted to hospital with low or moderate severity and uncomplicated pneumonia, 7 days of appropriate antibiotics is recommended. [C] | (1.2.10) Offer a 5-day course of a single antibiotic to patients with low-severity community-acquired pneumonia. (1.2.15) Consider a 7- to 10-day course of antibiotic therapy for patients with moderate or high-severity community-acquired pneumonia. | Duration of antibiotic therapy NICE recommends that in low severity CAP, a 5-day course of antibiotic therapy is offered, not a 7-day course. NICE recommends that in moderate severity CAP, a 7- to 10-day course of antibiotic therapy is considered, not just a 7 day course. Both guidelines recommend a 7- to 10-day course of antibiotic therapy in high severity CAP. |
*A full description of the guideline statement grades is provided in reference.1
BTS, British Thoracic Society; CAP, community acquired pneumonia; NICE, National Institute for Health and Care Excellence.