The National Institute for Health and Care Excellence has told GPs they should use a simple blood test to help determine whether patients have a bacterial or viral chest infection before deciding on treatment.

In its first ever guideline to improve care for up to 480,000 people who develop pneumonia every year and reduce their risk of death, the cost watchdog has recommended that GPs use the C-reactive protein (CRP) test if it is unclear whether a patient has pneumonia.

The move is designed to help steer the appropriate use of antibiotics, overuse of which has led to a sharp rise in antimicrobial resistance that is now claiming more that 25,000 deaths a year in Europe. Jonathan Cooke, Visiting Professor in Infectious Diseases at Imperial College London, says evidence shows CRP testing in primary care can reduce antibiotic prescribing by as much as 36%.

“With growing concern over antibiotic resistance, the CRP test is an important tool that can help GPs reduce antibiotic prescribing whilst still being confident about offering patients the best treatment,” noted Michael Moore, a GP and member of the guideline development group.   

Better assessment

The recommendations also advise GPs on how to better identify cases of severe pneumonia, the types of antibiotics to use and for how long, and when to refer to hospital. The Institute is also calling on hospitals to ensure procedures are in place for diagnosis (including X-rays) and prompt treatment (within four hours of admission).

Currently, almost half (42%) of patients diagnosed with pneumonia by their GP will go to hospital, and around 10% of these end up in intensive care with a 30% risk of dying, highlighting the significant room for improvement.

Professor Mark Baker, NICE’s director of clinical practice, said accurate assessment and treatment of pneumonia “both reduces costs and any potential harm from over-exposure to antibiotics,” and stressed the need to ensure that clinicians “are absolutely clear on the best way to treat people with pneumonia, whether that’s in hospital or in the community”.