NICE guideline on antibiotic prescribing in RTIs

NICE has published guidance on the appropriate prescribing of antibiotics for respiratory tract infections (RTIs) in primary care.

The guideline recommends that alternative prescription strategies for RTIs, including no antibiotic prescribing, delayed (or deferred) antibiotic prescribing and immediate antibiotic prescribing, are used.


  • At first face-to-face contact offer a clinical assessment, including history and examination, to establish diagnosis and exclude complications.
  • Agree a no antibiotic or delayed antibiotic prescribing strategy for patients with acute otitis media, acute sore throat/pharyngitis/acute tonsillitis, common cold, acute rhinosinusitis or acute cough/acute bronchitis.

No antibiotic prescribing

  • Reassure patients that antibiotics are not needed immediately because they will make little difference to symptoms and may have side effects.
  • Offer a clinical review if the RTI worsens or becomes prolonged.

Delayed antibiotic prescribing

  • Reassure patients that antibiotics are not needed immediately.
  • Issue a prescription for delayed use along with advice about using the prescription if symptoms do not settle or get significantly worse.
  • Advise patient to re-consult if symptoms get worse despite using the delayed prescription.

Immediate antibiotic prescribing
Offer immediate antibiotics or further investigation for patients with:

  • Symptoms suggestive of serious illness.
  • A high risk of serious complications due to pre-existing comorbidity, e.g. significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis or young children who were born prematurely.
  • Acute cough and age >65 years with two or more of the following, or >80 years with 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.
  • Consider for children under two years with bilateral acute otitis media, children with otorrhoea who have acute otitis media, and patients with acute sore throat when three or more Centor criteria are present.

The full guideline is available at NICE

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