NICE guidance - antibiotic prescribing for self-limiting respiratory tract infections

Last edited 03/2020 and last reviewed 09/2021

A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for patients with the following conditions:

• acute otitis media
• acute sore throat/acute pharyngitis/acute tonsillitis
• common cold
• acute rhinosinusitis
• 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):

• bilateral acute otitis media in children younger than 2 years
  
  
• acute otitis media in children with otorrhoea
  
  
• acute sore throat/acute pharyngitis/acute tonsillitis when three or more 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: four days
  • acute sore throat/acute pharyngitis/acute tonsillitis: one week
  • common cold: one and a half weeks
  • acute rhinosinusitis: two and a half weeks
  • acute cough/acute bronchitis: three weeks
• When the no antibiotic prescribing strategy is adopted, patients should be offered:
  • 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
  • a clinical review if the condition worsens or becomes prolonged
• When the delayed antibiotic prescribing strategy is adopted, patients should be offered:
  • 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
  • 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

Updated NICE prescribing guidance has been given with respect to cough, sore throat, sinusitis and otitis media - these are linked.

Reference:

• (1) NICE (June 2008).Respiratory tract infections - antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care