Respiratory tract infections - antibiotic prescribing Implementing NICE guidance 2008 NICE clinical...
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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
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
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
Recommendations :Offer a clinical assessment
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)
•Advice about the usual natural history of the illness
•Advice about managing symptoms, including fever
Recommendations : Give advice
For all antibiotic prescribing strategies, patients should be given:
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
Recommendations :Antibiotic prescribing options - 1
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
•Reassurance that antibiotics are not needed immediately
•A clinical review if the condition worsens or becomes prolonged
Recommendations : When no 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
Recommendations :When delayed antibiotic
prescribing is agreedOffer patients:
•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
Recommendations :Consider immediate antibiotic prescribing for
patients at risk of developing complications (1)
Immediate antibiotic prescribing and/or further investigation/management should only be offered to adults and children in the following situations:
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
Costs and savings per 100,000 population
Recommendations with significant savingsSavings
(£ per year)
A no or a delayed antibiotic prescribing strategy should be agreed for patients with the following conditions: acute otitis media, acute cough/acute bronchitis, acute sore throat/acute pharyngitis/acute tonsillitis, acute rhinosinusitis and common cold –4,200
Estimated saving of implementation –4,200
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
For discussionHow 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?
Find out more
Visit www.nice.org.uk/CG069 for:
•Other guideline formats•Costing report and template•Audit support