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RESPIRATORY TRACT INFECTIONS: ANTIBIOTIC PRESCRIBING

RESPIRATORY TRACT INFECTIONS: ANTIBIOTIC PRESCRIBING. A Summary of the NICE guidance. RATIONALE.

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RESPIRATORY TRACT INFECTIONS: ANTIBIOTIC PRESCRIBING

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  1. RESPIRATORY TRACT INFECTIONS:ANTIBIOTIC PRESCRIBING A Summary of the NICE guidance

  2. RATIONALE • “Evidence shows that antibiotics have limited effectiveness in treating a large proportion of RTIs in adults and children and complications are likely to be rare if antibiotics are withheld. General practice consultation rates in England and Wales show that a quarter of the population will visit their GP because of an RTI each year and they are the reason for 60% of all antibiotic prescribing in general practice.”

  3. DEFINITIONS • Respiratory tract infection (RTI) is defined as any infectious disease of the upper or lower respiratory tract. • Upper respiratory tract infections (URTIs) include the common cold, laryngitis, pharyngitis/tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. • Lower respiratory tract infections (LRTIs) include acute bronchitis, bronchiolitis, pneumonia and tracheitis.

  4. STATING THE OBVIOUS • “At the first face-to-face contact in primary care, including walk-in centres and emergency departments, offer a clinical assessment, including: • a history (presenting symptoms, use of OTC/self medication, PMH, risk factors, co-morbidities • examination to establish diagnosis and exclude complications”

  5. OFFER TO ALL PATIENTS • Advice about the usual natural history and average total duration of the illness • acute otitis media acute otitis media: 4 days • acute sore throat/pharyngitis/tonsillitis: 1 week • common cold: 1.5 weeks • acute rhinosinusitis: 2.5 weeks • acute cough/acute bronchitis : 3 weeks • Advice about managing symptoms including fever (i.e. analgesia, antipyretics etc.)

  6. PRESCRIBING STRATEGIES • No prescribing • Delayed prescribing • Issuing a prescription and advising that it be cashed if symptoms worsen or fail to improve within a given timeframe • Immediate prescribing

  7. DO NOT PRESCRIBE 1 • “Negotiate a no antibioticordelayed antibiotic prescribing strategy for patients with: • acute otitis media acute otitis media • acute sore throat/pharyngitis/tonsillitis • common cold • acute rhinosinusitis • acute cough/acute bronchitis”

  8. DO NOT PRESCRIBE 2 • If you don’t prescribe, offer patients • Reassurance that antibiotics are not needed immediately because they will make little difference to symptoms and may have side effects and a clinical review if the RTI worsens or becomes prolonged • Safety netting

  9. DO NOT PRESCRIBE 3 • For the delayed antibiotic prescribing, offer patients • Reassurance that antibiotics are not needed immediately because they will make little difference to symptoms and may have side effects • Advice about using the delayed prescription if symptoms do not settle or get significantly worse • Advice about re-consulting if symptoms get significantly worse despite using the delayed prescription

  10. CONSIDER PRESCRIBING • Consider a no antibiotic, delayed antibioticor an immediate antibiotic prescribing strategy (depending on severity) for: • Children younger than 2 years with bilateral acute otitis media • Children with otorrhoea who have acute otitis media • Patients with acute sore throat/acute tonsillitis when three or more *Centor criteria are present

  11. *CENTOR CRITERIA • Presence of tonsillar exudate • Tender anterior cervical lymphadenopathy or lymphadenitis • History of fever • Absence of cough

  12. DO PRESCRIBE • Offer immediate antibiotics or further investigation/management for patients who: • are systemically unwell • have symptoms and signs suggestive of serious illness and/or complications (particularly pneumonia, mastoiditis, peritonsillar abscess, peritonsillar cellulitis, intraorbital or intracranial complications) • are at high risk of serious complications because of pre-existing comorbidity. This includes patients with significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis, and young children who were born prematurely. • are older than 65 years with acute cough and two or more of the following, or older than 80 years with acute cough and one or more of the following: • hospitalisation in previous year • type 1 or type 2 diabetes • history of congestive heart failure • current use of oral glucocorticoids

  13. THE END QUESTIONS?

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