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Living Guide

This living document is produced by the GP medical directors of Londonwide LMCs in collaboration with clinical colleagues within the NHS system in London to guide London’s GP practices to best help our patients.
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Management of Covid-19 related, suspected or confirmed pneumonia

NICE have produced a very helpful guideline ‘Covid-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community’ that covers:

  • Deciding about hospital admission.
  • Managing breathlessness.
  • Antibiotic treatment.
  • Oral corticosteroids.
  • Safety-netting and review.

Key NICE messages regarding antibiotic use:

  1. Do not offer an antibiotic for treatment or prevention of pneumonia if Covid-19 is likely to be the cause and symptoms are mild.
  2. Offer an oral antibiotic for treatment of pneumonia in people who can or wish to be treated in the community if:
    1. the likely cause is bacterial, or
    2. it is unclear whether the cause is bacterial or viral and symptoms are more concerning.
      To help differentiate between bacterial and viral pneumonia the Centre for Evidence Based Medicine have produced some guidance, or
    3. they are at high risk of complications because, for example, they are older or frail, or have a pre-existing comorbidity such as immunosuppression or significant heart or lung disease (for example bronchiectasis or COPD), or
    4. they have a history of severe illness following previous lung infection.
  3. When starting antibiotic treatment, the first-choice oral antibiotic is:
    • Doxycycline 200 mg on the first day, then 100 mg once a day for five days in total (not in pregnancy).
    • Alternative: amoxicillin 500 mg three times a day for five days.
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