Referral for Antibiotics


At this time of year there are lots of patients with coughs and colds who are asking for advice and treatments.

The following information comes from the North East & Cumbria Antibiotic Prescribing Guideline for Primary Care and is what GPs and other prescribers use when assessing whether patients require  antibiotics.

As healthcare professionals we are actively working to reduce inappropriate antibiotic prescribing, so it may be helpful to print a copy to keep in the pharmacy for discussion with patients, to explain how long symptoms are expected to last and that antibiotics are likely to be unnecessary if their symptoms are within the normal duration of symptoms.

If you do refer a patient to their GP, please make sure that they understand they may not get an antibiotic, depending on their symptoms.

Click here to download the information sheet

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Respiratory Tract Infections

Antibiotics are rarely necessary as most upper respiratory tract infections are self-limiting. Provide patients with advice about total illness length and advice regarding management of symptoms, particularly analgesics and antipyretics.

Acute rhinosinusitis – avoid antibiotics, 80% resolve in 14 days without, and they only offer marginal benefit after 7 days

Acute otitis media in children – avoid antibiotics as 60% are better within 24 hours

Acute cough, bronchitis – antibiotics of little benefit if no co-morbidity. Consider delayed antibiotic with advice. Consider immediate antibiotics if:

  • >80years and one of:
    • hospitalisation in the past year
    • oral steroids
    • diabetic
    • congestive heart failure
  • OR >65 years with two of the above.

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Sore Throat

 

General guidelines for sore thoats

  • The majority of sore throats are viral
  • Most patients do not benefit from antibiotics
  • 90% of cases resolve in 7 days without antibiotics
  • pain only reduced by 16 hours if antibiotics are used
  • Adequate analgesia and fluids will usually be all that is required

 

If you think antibiotics may be required:

  • Use Centor criteria score to help decide whether to prescribe an antibiotic.

 

Centor Criteria

Symptoms Score
Is there fever / temperature of 38 o C (100 o F) or more?

Yes – score 1

No – score 0

Is there a cough?

Yes – score 0

No – score 1

Are there tender anterior cervical lymphadenopathy / swollen, tender glands in the neck?

Yes – score 1

No – score 0

Are the tonsils swollen & producing pus / exudate?

Yes – score 1

No – score 0

 

  • A low Centor score (0-2) indicates a low chance of Group A Beta-haemolytic Streptococci (GABHS)
  • Patients with 3-4 Centor score or history of otitis media consider a 2 or 3 day delayed antibiotic prescription strategy  or immediate antibiotics
  • When using a delayed antibiotic prescription strategy, if possible, leave the script in reception for later pick-up rather than giving it to the patient.

 

 

 

 

Respiratory Tract Infections

 

Average length of illness and symptoms

It may be helpful to understand how long it can take symptoms to clear up by themselves:

  • Ear ache: 4 days
  • Sore throat / Acute tonsillitis: 1 week
  • Common cold: 1½ weeks
  • Sinusitis: 2½ weeks
  • Bronchitis: 3 weeks
  • Cough associated with cold / bronchitis: 3 weeks

Note: these are average lengths; about one half of all patients will have symptoms for longer.

 

The graph below gives an estimate of how long you can expect the symptoms of a common cold to continue.


Cold symptoms duration