Respiratory Tract Infections
Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care
1 Summary
1.1. List of all recommendations
The clinical effectiveness and cost effectiveness of antibiotic management strategies for respiratory tract infections (RTIs)
- 1.1.1.
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At the first face-to-face contact in primary care, including walk-in centres and emergency departments, adults and children (3 months and older) presenting with a history suggestive of the following conditions should be offered a clinical assessment.
- acute otitis media
- acute sore throat/acute pharyngitis/acute tonsillitis
- common cold
- acute rhinosinusitis
- acute cough/acute bronchitis.
The clinical assessment should include a history (presenting symptoms, use of over-the-counter or self medication, previous medical history, relevant risk factors, relevant comorbidities) and, if indicated, an examination to identify relevant clinical signs.
- 1.1.2.
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Patients’ or parents’/carers’ concerns and expectations should be determined and addressed when agreeing the use of the three antibiotic prescribing strategies (no prescribing, delayed prescribing and immediate prescribing).
- 1.1.3.
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A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for patients with the following conditions:
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acute otitis media
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acute sore throat/acute pharyngitis/acute tonsillitis
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common cold
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acute rhinosinusitis
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acute cough/acute bronchitis.
Depending on clinical assessment of severity, patients in the following subgroups can also be considered for an immediate antibiotic prescribing strategy (in addition to a no antibiotic or a delayed antibiotic prescribing strategy):
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bilateral acute otitis media in children younger than 2 years
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acute otitis media in children with otorrhoea
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acute sore throat/acute pharyngitis/acute tonsillitis when three or more Centor criteria1 are present.
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- 1.1.4.
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For all antibiotic prescribing strategies, patients should be given:
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advice about the usual natural history of the illness, including the average total length of the illness (before and after seeing the doctor):
- –acute otitis media: 4 days
- –acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
- –common cold: 1½ weeks
- –acute rhinosinusitis: 2½ weeks
- –acute cough/acute bronchitis: 3 weeks
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advice about managing symptoms, including fever (particularly analgesics and antipyretics). For information about fever in children younger than 5 years, refer to ‘Feverish illness in children’ (NICE clinical guideline 47).
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- 1.1.5.
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When the no antibiotic prescribing strategy is adopted, patients should be offered:
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reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, diarrhoea, vomiting and rash
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a clinical review if the condition worsens or becomes prolonged.
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- 1.1.6.
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When the delayed antibiotic prescribing strategy is adopted, patients should be offered:
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reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects, for example, vomiting and rash
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advice about using the delayed prescription if symptoms are not starting to settle in accordance with the expected course of the illness or if a significant worsening of symptoms occurs
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advice about re-consulting if there is a significant worsening of symptoms despite using the delayed prescription.
A delayed prescription with instructions can either be given to the patient or left at an agreed location to be collected at a later date.
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