For patients with low-severity CAP, NICE recommends a 5€‘day course of a single antibiotic, with amoxicillin preferred to a macrolide or a tetracycline, unless the patient is allergic to penicillins.6

Currently, CG191 says that if there is no improvement after three days or if symptoms worsen in the meantime, it may be necessary to extend the course of antibiotics beyond five days, but this is set to change later this year when updated guidelines are adopted (see below).

For moderate to high severity CAP, the initial length of the course of antibiotics has been seven to 10 days. For moderate CAP, NICE has recommended dual antibiotic therapy with amoxicillin and a macrolide, if there are no allergy concerns. For severe CAP, dual antibiotic therapy with a beta€‘lactamase stable beta€‘lactam and a macrolide has been the starting point.