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1
NICE 69: National Institute for Health and Clinical Excellence. Prescribing of antibiotics for self-limiting respiratory tract
infections in adults and children in primary care. 2008. (Clinical guideline 69).

A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be negotiated for patients with the following conditions: acute otitis media, acute sore throat, common cold, acute rhinosinusitis, acute cough/acute bronchitis. Depending on patient preference and clinical assessment of severity, patients in the following specific subgroups can also be considered for immediate antibiotics in addition to the reasonable options of a no antibiotic strategy or a delayed prescribing strategy:

  • bilateral acute otitis media in children under two years
  • acute otitis media in children with otorrhoea
  • acute sore throat/acute tonsillitis when three or four of the Centor criteria are present

For all antibiotic prescribing strategies, patients should be given 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: 11⁄2 weeks
  • acute rhinosinusitis: 21⁄2 weeks
  • acute cough/acute bronchitis: 3 weeks

Advice should also be given about managing symptoms, including fever (particularly analgesics and antipyretics).

When the delayed antibiotic prescribing strategy is adopted, patients should be offered the following:

  • reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects
  • 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
  • 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.

2
The Royal College of General Practitioners (RCGP) has a free two hour training module on Managing Acute Respiratory Tract Infections (MARTI) for continued professional development. The MARTI series of training modules enables clinical staff to improve the care provided to patients presenting with acute ear pain, acute sore throat, sinusitis and acute cough. The module equals two hours towards CPD, and can be imported into the RCGP Revalidation portfolio. http://www.rcgp.org.uk/courses-and-events/online-learning/ole/managing-acute-respiratory-tract-infections.aspx

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).