Quality statement 3: Duration of initial antibiotic treatment
Quality statement
People with community-acquired or hospital-acquired pneumonia are initially prescribed antibiotic treatment for 5 days, or 3 days for children aged 3 months to 11 years with community-acquired pneumonia and non-severe symptoms. [2016, updated 2025]
Rationale
Community-acquired and hospital-acquired pneumonia are usually caused by bacteria and should be treated with antibiotic therapy. A single course of antibiotic is usually an effective treatment for community-acquired or hospital‑acquired pneumonia unless symptoms do not improve. Prescribing an initial course that is not given for longer than necessary will contribute to effective antimicrobial stewardship. In hospital, a review of antibiotic treatment within 48 to 72 hours is recommended in the UKHSA Start Smart Then Focus guidance in order to review and revise the clinical diagnosis and the continuing need for antimicrobials.
Quality measures
Process
a) Proportion of children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications or underlying disease who were prescribed an initial 3‑day course of antibiotic treatment.
Numerator – the number in the denominator who were prescribed an initial 3‑day course of antibiotic treatment.
Denominator – the number of children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications or underlying disease.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from electronic patient records.
b) Proportion of people with community-acquired pneumonia or hospital-acquired pneumonia (excluding children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications or underlying disease) who were prescribed an initial 5‑day course of antibiotic treatment.
Numerator – the number in the denominator who were prescribed an initial 5‑day course of antibiotic treatment.
Denominator – the number of people with community-acquired pneumonia or hospital-acquired pneumonia (excluding children aged 3 months to 11 years with non-severe community-acquired pneumonia without complications or underlying disease).
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from electronic patient records.
What the quality statement means for different audiences
Service providers (primary and secondary care services) ensure that systems are in place for people diagnosed with community-acquired or hospital-acquired pneumonia to be initially prescribed antibiotic treatment for 3 or 5 days. They ensure that staff are aware that children aged 3 months to 11 years with non-severe community-acquired pneumonia, without complications or underlying disease are prescribed an initial 3‑day course of antibiotic. They ensure staff are aware that everyone else with community-acquired pneumonia, and everyone with hospital acquired pneumonia, are prescribed an initial 5‑day course of antibiotic treatment.
Healthcare professionals (such as paramedics working in primary care, GPs, secondary and community care doctors and nurses) prescribe an initial 3‑day course of antibiotics for children aged 3 months to 11 years with non-severe community-acquired pneumonia, without complications or underlying disease. For everyone else with community-acquired pneumonia, and those with hospital-acquired pneumonia, they prescribe initial antibiotic treatment for 5 days.
Commissioners ensure that they commission services in which people with community-acquired or hospital-acquired pneumonia are initially prescribed antibiotic treatment for 5 days, or 3 days for children aged 3 months to 11 years with non-severe community-acquired pneumonia, without complications or underlying disease.
Children aged 3 months to 11 years with community-acquired pneumonia that is not severe are prescribed initial antibiotic treatment for 3 days if they have no complications or other underlying health conditions. If they do have complications or other underlying health conditions, they are prescribed initial antibiotic treatment for 5 days.
Everyone else with community-acquired pneumonia is prescribed initial antibiotic treatment for 5 days.
People with hospital-acquired pneumonia are prescribed initial antibiotic treatment for 5 days.
Source guidance
Pneumonia: diagnosis and management. NICE guideline NG250 (2025), recommendations 1.6.2, 1.6.4 and 1.7.3
Definitions of terms used in this quality statement
Community-acquired pneumonia
Pneumonia that is acquired outside hospital, or within 48 hours of admission. Pneumonia that develops in a nursing home resident is included in this definition. When managed in hospital the diagnosis is usually confirmed by chest X‑ray. [NICE's guideline on pneumonia, terms used in this guideline]
Hospital-acquired pneumonia
Pneumonia that develops 48 hours or more after hospital admission and that was not incubating at hospital admission, or people who present to hospital with pneumonia but who have been discharged within the last 7 to 10 days. When managed in hospital, the diagnosis is usually confirmed by chest X‑ray. [NICE's guideline on pneumonia, terms used in this guideline]
Severe community-acquired pneumonia in children and young people
Severe community acquired pneumonia in babies, children and young people is a diagnosis made by the treating physician. Features of this may include difficulty breathing, oxygen saturation less than 90% (percutaneous oxygen saturation monitors may be inaccurate in people with pigmented skin), raised heart rate, grunting, severe chest indrawing, inability to breastfeed or drink, lethargy and a reduced level of consciousness. [NICE's guideline on pneumonia, terms used in this guideline]