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Adult Treatment - Upper Respiratory Tract Infections



See PHE Influenza guidance for treatment of patients under 13 years or in severe immunosuppression (and seek advice).

See NICE Influenza for prophylaxis

Annual vaccination is essential for all those at risk of influenza.

Medicine Calendar

For otherwise healthy adults anti-virals are not recommended.

Treat 'at risk' patients, when influenza is circulating in the community and ideally within 48 hours of onset (do not wait for lab report) or in a care home where influenza is likely.

At risk: pregnant (including up to two weeks post-partum), 65 years or over, chronic respiratory disease (including COPD and asthma), significant cardiovascular disease (not hypertension), immunocompromised, diabetes mellitus, chronic neurological, renal or liver disease, morbid obesity (BMI equal to or over 40). Use 5 days treatment with oseltamivir 75mg BD. If resistant to oseltamivir or severely immunosuppressed, use zanamivir 10mg BD (2 inhalations by diskhaler for up to 10 days) and seek advice.

Acute sore throat


Avoid antibiotics as 90% resolve in 7 days without1 A+, and pain only reduced by 16 hours 2 A+.

Use FeverPAIN Score: Fever in last 24h, Purulence, Attend rapidly under 3 days, severely Inflamed tonsils, No cough or coryza.3 B+ 4 B+

Score 0-1: 13-18% streptococci, use NO antibiotic strategy
Score 2-3: 34-40% streptococci, use 3 day back-up antibioitc
Score 4 or more: 62-65% streptococci, use immediate antibiotic if severe, or 48hr short back-up prescription.5 A-

Always share self-care advice and safety net.

Antibiotics to prevent Quinsy NNT >4000 4 B-
Antibiotics to prevent Otitis media NNT 200 2 A+

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Phenoxymethylpenicillin 5 B-

500mg QDS or 1g BD 6 A+

10 days 8 A-

For severe cases
Phenoxymethylpenicillin 5 B-

500mg QDS 7 D

10 days 8A-

If Penicillin Allergic

250-500mg BD

5 days 9 A+

If pregnant AND penicillin Allergic

500mg QDS 10A+

5 days 9 A+ 10 D

Acute otitis externa


First use analgesia.

Cure rates similar at 7 days for topical acetic acid or antibiotic +/- steroid1A+

If cellulitis or disease extending outside ear canal, start oral antibiotics and refer to exclude malignant OE2A+

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First line:
acetic acid 2%

1 spray TDS

7 days

Second line
neomycin sulphate with corticosteroid 3A+,4D

3 drops TDS

7 days minimum to 14 days maximum1A+

Acute rhinosinusitis 5C


Avoid antibiotics as 80% resolve in 14 days without; and they only offer marginal benefit after 7 days NNT15 2,3 A+

Use adequate analgesia 4 B+ Consider 7-day delayed or immediate antibiotic when purulent nasal discharge NNT8 1,2 A+

In persistent infection use an agent with anti- anaerobic activity e.g. co-amoxiclav 6 B+

Medicine Calendar

amoxicillin 4 A+,7 A

500mg TDS.
If severe 1g TDS 11 D

7 days 9 A+


200mg stat on Day 1 and then 100mg OD Day 2 onwards

7 days

phenoxymethylpenicillin 8 B+

500mg QDS

7 days

For persistent symptoms:
co-amoxiclav 6 B+

625mg TDS

7 days

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).