The BTS CAP Guideline and the NICE Pneumonia Guideline

Results

The NICE Guideline contains 27 recommendations, of which 3 relate to hospital acquired pneumonia, one to lower respiratory tract infections including CAP and 23 specifically to CAP. The BTS Guideline contains 137 recommendations, all relating specifically to CAP. Of these 137 recommendations, 36 overlapped with NICE Guideline recommendations. Major differences with the NICE Guideline were considered to exist for only five BTS recommendations (see Table 1).

In particular, no major differences were noted in the recommendations pertaining to the key aspects of the management of CAP: severity assessment, antibiotic choice and timeliness of treatment. Both guidelines recommend the use of:

1. 
   clinical judgement in conjunction with the CURB-65 score (CRB65 score for primary care) to assess illness severity,
   
2. 
   a single antibiotic as initial empirical therapy in patients with low severity CAP,
   
3. 
   dual combination antibiotics comprising amoxicillin and a macrolide for patients with moderate severity CAP, and
   
4. 
   dual combination antibiotics comprising a β-lactamase stable β-lactam (such as co-amoxiclav) and a macrolide for patients with high severity CAP.
   

In addition, both guidelines recommend that processes are be put in place to allow the radiological diagnosis and treatment of patients with CAP within 4 h of presentation to hospital.