Respiratory tract infections: NICE guidelines
NICE issued guidance in 2008 on the management of respiratory tract infection, focusing on the prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care
A no antibiotic prescribing or delayed antibiotic prescribing approach is generally recommended for patients with acute otitis media, acute sore throat/acute pharyngitis/acute tonsillitis, common cold, acute rhinosinusitis or acute cough/acute bronchitis.
However, an immediate antibiotic prescribing approach may be considered for:
The Centor criteria* are as follows:
If the patient is deemed at risk of developing complications, an immediate antibiotic prescribing policy is recommended
The guidelines also suggest that patients should be advised how long respiratory tract infections may last:
*if 3 or more of the criteria are present there is a 40-60% chance the sore throat is caused by Group A beta-haemolytic Streptococcus
A no antibiotic prescribing or delayed antibiotic prescribing approach is generally recommended for patients with acute otitis media, acute sore throat/acute pharyngitis/acute tonsillitis, common cold, acute rhinosinusitis or acute cough/acute bronchitis.
However, an immediate antibiotic prescribing approach may be considered 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 pharyngitis/acute tonsillitis when 3 or more Centor criteria are present
The Centor criteria* are as follows:
- presence of tonsillar exudate
- tender anterior cervical lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
If the patient is deemed at risk of developing complications, an immediate antibiotic prescribing policy is recommended
- are systemically very 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
The guidelines also suggest that patients should be advised how long respiratory tract infections may last:
- acute otitis media: 4 days
- acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
- common cold: 1 1/2 weeks
- acute rhinosinusitis: 2 1/2 weeks
- acute cough/acute bronchitis: 3 weeks
*if 3 or more of the criteria are present there is a 40-60% chance the sore throat is caused by Group A beta-haemolytic Streptococcus