NICE COVID-19 guidance on immunocompromised children and antibiotics for pneumonia
NICE has published a new series of guidelines in the wake of COVID-19, including guidance on the care of children and young people who are immunocompromised.
The guideline on immunocompromised children and young people emphasises that COVID-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised. (https://www.nice.org.uk/guidance/NG174)
Healthcare professionals are advised to discuss the risks and benefits of continuing or stopping treatment and to reassure patients and their carers that immunosuppression does not appear to increase the risk of severe COVID-19. Patients should not miss their usual appointments, should continue with their treatment and speak to their specialist team if they have been told they are in a shielded group.
If COVID-19 is suspected, patients and their carers are advised to contact their specialist team as soon as possible. If they are unable to get in touch, they should ring NHS 111 for further advice or 999 in an emergency. For children and young people with complex care needs, parents and carers should have a plan in place should they themselves become ill so that the patient can continue to receive care safely.
Ultimately, healthcare professionals should take a person-centred approach when treating immunocompromised children and young people during the COVID-19 pandemic. This can be an unsettling time for all, particularly for children and young people, parents and carers of those who are immunocompromised, so it is important that patients are involved in decision making as much as possible.
The second guideline on antibiotics for pneumonia in adults in hospital emphasises the importance of careful antibiotic prescribing and prompt review after testing. It aims to ensure that patients receive the best possible care whilst enabling services to make the best use of NHS resources. (https://www.nice.org.uk/guidance/NG173)
It is important to note that during the COVID‑19 pandemic, most cases of pneumonia have been viral and therefore antibiotics are ineffective unless there is a bacterial co-infection. Inappropriate use of antibiotics can affect the medicines supply chain as well as leading to Clostridioides difficile infection and antimicrobial resistance.
For patients with suspected or confirmed bacterial pneumonia, a broad-spectrum antibiotic should be given as soon as possible unless there is significant confidence about the absence of bacterial co-infection. If a patient has suspected sepsis, antibiotics must be started within 1 hour of admission. Tests such as blood and sputum samples should be used to inform the review of antibiotics after 24 hours or as soon as results are available.
Further tests to inform the diagnosis should be carried out, which may include upper and lower respiratory tract specimens; chest imaging techniques that provide more detail than chest X-rays may be required. Patients should be encouraged to consider enrolling in COVID-19 clinical trials, if possible.
Clinicians are advised that there is currently insufficient evidence to recommend routine procalcitonin (PCT) testing to guide decisions around antibiotic usage. Further research is needed to demonstrate how useful this test is in identifying whether there is a bacterial infection.
The latest COVID-19 guidance on pneumonia antibiotic prescribing will replace existing NICE guidance on pneumonia during the pandemic (https://www.nice.org.uk/guidance/cg191). NICE will publish new guidelines, each based on the priorities for patients and the NHS. Further guidelines will be announced in due course.
NICE will also make the guidelines internationally available so that health systems around the world can see the approach the UK is taking. The guidelines are being produced in collaboration with NHS England/Improvement and a cross-specialty clinical group, supported by the specialist societies and Royal Colleges.