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Respiratory tract infections - antibiotic prescribing

Respiratory tract infections - antibiotic prescribing. Implementing NICE guidance. 2008. NICE clinical guideline 69. What this presentation covers. Background Recommendations Costs and savings Discussion Find out more . Background.

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Respiratory tract infections - antibiotic prescribing

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  1. Respiratory tract infections - antibiotic prescribing Implementing NICE guidance 2008 NICE clinical guideline 69

  2. What this presentation covers • Background • Recommendations • Costs and savings • Discussion • Find out more

  3. Background • RTIs are the commonest acute problem dealt with in primary care • Most people with RTIs are inappropriately prescribed antibiotics • The guideline covers best practice advice on the care of adults and children (3 months and older) with RTIs, for whom immediate antibiotic prescribing is not indicated

  4. Recommendations :Offer a clinical assessment At first face-to-face contact in primary care,patients presenting with a history suggestive of the following should be offered a clinical assessment: - Acute otitis media - Acute sore throat/acute pharyngitis/acute tonsillitis - Common cold - Acute rhinosinusitis - Acute cough/acute bronchitis

  5. Recommendations : Agree an antibiotic prescribing strategy with the patient Patients’ or parents’/carers’concerns and expectations should be determined and addressed when agreeing the use of the three antibiotic prescribing strategies (no prescribing, delayed prescribing and immediate prescribing)

  6. Recommendations : Give advice • Advice about the usual natural history of the illness • Advice about managing symptoms, including fever For all antibiotic prescribing strategies, patients should be given:

  7. Recommendations :Antibiotic prescribing options - 1 A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for most patients with the following conditions: • Acute otitis media • Acute sore throat/acute pharyngitis/acute tonsillitis • Common cold • Acute rhinosinusitis • Acute cough/acute bronchitis

  8. Recommendations : Antibiotic prescribing options - 2 Depending on clinical assessment of severity, patients in the following subgroups can also be considered for immediate antibiotics: • 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 three or more Centor criteria are present

  9. Recommendations : When no antibiotic prescribing is agreed • Reassurance that antibiotics are not needed immediately • A clinical review if the condition worsens or becomes prolonged Offer patients:

  10. Recommendations :When delayed antibiotic prescribing is agreed Offer patients: • Reassurance that antibiotics are not needed immediately • Advice about using the delayed prescription if symptoms are not starting to settle in accordance with the expected course of the illness • Advice about re-consulting if there is a significant worsening of symptoms despite using the prescription

  11. Recommendations :Consider immediate antibiotic prescribing for patients at risk of developing complications (1) • If the patient is systemically very unwell • If the patient has symptoms and signs of serious illness and/or complications • If the patient is at high risk of serious complications because of pre-existing comorbidity Immediate antibiotic prescribing and/or further investigation/management should only be offered to adults and children in the following situations:

  12. Recommendations :Consider immediate antibiotic prescribing for patients at risk of developing complications (2) • If the patient is older than 65 with acute cough and two or more of the following or older than 80 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. Costs and savings per 100,000 population

  14. Costs and savings • The guideline on respiratory tract infections in primary care - antibiotic prescribing is unlikely to result in a significant change in resource use in the NHS

  15. For discussion • How does the rate of antibiotic prescribing for RTIs in your practice/PCT compare with the PCT/national average? • How could the delayed prescribing strategy be implemented in your surgery/PCT? • What methods/tools could be used to help patients take a greater role in self-managing their uncomplicated RTIs? • How can we use the NICE Audit Support document to assess local implementation?

  16. Find out more • Visit www.nice.org.uk/CG069 for: • Other guideline formats • Costing report and template • Audit support

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