BTS guidelines on CAP

The new BTS guidelines on the management of community acquired pneumonia (CAP) in adults ¹ are welcome if they lead to improved diagnosis of pneumonia, better assessment of severity of illness, and thus more appropriate treatment according to clinical needs. It is widely accepted, however, that inappropriate implementation of the previous guideline contributed to large increases in unnecessary use of broad spectrum antibiotics with resultant increases in antibiotic resistance and Clostridium difficile infection. The authors acknowledge this, but the new guidelines seem likely to continue this unfortunate trend.

Firstly, there is no mention of the use of oral penicillin for treatment of mild cases of CAP. This is a first line choice in Scandinavian countries which have a commendably restrained history of antibiotic use (and consequently low rates of resistance). ² The new BTS guideline recommendation for widespread use of...