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NICE: Cut down on Antibiotics Prescribing

Posted Oct 03 2008 11:31am
The National Institute for Health and Clinical Excellence (NICE) recently released their latest guideline on antibiotic prescribing in respiratory tract infections, suggest the doctors to cut down their antibiotic prescriptions.

Although the guideline is targeted on doctors in UK, I think, it's applicable for doctors all around the world.


Links:
Respiratory tract infections: full guideline
Respiratory tract infections: quick reference guide

Overuse of antibiotic is a growing concern for healthcare professionals world wide, as there are increasing number of antibiotic resistant bacteria reported, such as methicillin-resistant Staphylococcus aureus (MRSA).

As most of the acute respiratory infections are viral infections, antibiotic has limited role in treating them.


According to the guideline, antibiotic should not be prescribed immediately to patients come in with:
  • Acute otitis media
  • Acute sore throat/pharyngitis/tonsillitis
  • Common cold
  • Acute rhinosinusitis
  • Acute cough/acute bronchitis

Otitis Media is an infection of the middle ear


Doctors should reassure the patients that antibiotics are not needed immediately for such diseases as they play no role to these diseases and may cause unnecessary adverse effects, such as diarrhea, vomiting and rash.

If the symptoms worsens or prolongs, then only the patient need another clinical review, to consider whether to prescribe antibiotics or not.

Patients should be educated on the nature of diseases, especially the natural average total illness length:
  • Acute otitis media - 4 days
  • Acute sore throat/pharyngitis/tonsillitis - 1 week
  • Common cold - 1.5 week
  • Acute rhinosinusitis - 2.5 weeks
  • Acute cough/acute bronchitis - 3 weeks
However, if the patients are seriously ill, or they are older than 65 years old with certain conditions, especially if they are on steroid drugs, antibiotics should be immediately prescribed.
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