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

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