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Practice Guidelines

Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance

BMJ 2008; 337 doi: (Published 23 July 2008) Cite this as: BMJ 2008;337:a437
  1. Toni Tan, technical analyst1,
  2. Paul Little, professor of primary care research and general practitioner2,
  3. Tim Stokes, associate director1
  4. on behalf of the Guideline Development Group
  1. 1National Institute for Health and Clinical Excellence, Manchester M1 4BD
  2. 2School of Medicine, University of Southampton, Southampton SO17 1BJ
  1. Correspondence to: P Little p.little{at}

    Why read this summary?

    Antibiotics probably provide little benefit for a large proportion of respiratory tract infections that present in primary care. Respiratory tract infections are largely self limiting, and complications are likely to be rare if antibiotics are withheld. However, respiratory tract infections account for 60% of all antibiotic prescribing in primary care,1 and the prescribing patterns for antibiotics vary widely among general practices, without evidence of significant benefit among higher prescribers. Three different management strategies for antibiotics can be used for patients with respiratory tract infection who present in primary care: no antibiotic prescribing; delayed (or deferred) prescribing, in which a prescription is written for use at a later date if symptoms worsen or do not start to settle in the expected timescale; and immediate prescribing. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on antibiotic prescribing for self limiting respiratory tract infections in primary care.2


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Management strategies for antibiotics

    Adults and children (3 months or older) with acute otitis media; acute sore throat, acute pharyngitis, or acute tonsillitis; common cold; acute rhinosinusitis; acute cough or acute bronchitis

    • At the first face to face contact in primary care, offer a clinical assessment that includes a history (presenting symptoms, use of over the counter or self medication, medical history, relevant risk factors, relevant comorbidities) and, if indicated, an examination to identify relevant clinical signs. [Based on the experience of the Guideline Development Group]

    • Address the concerns and expectations of patients, parents, or carers when agreeing with them which of the three antibiotic prescribing strategies to use (no prescribing, delayed prescribing, or immediate prescribing). [Based on the experience of the Guideline Development Group]

    • A no prescribing strategy or a …

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