Expert advice

Medicines management: Reducing antibiotic prescribing for upper respiratory tract infections

Overuse of antibiotics can lead to antibiotic resistance. This is becoming a major problem worldwide, and we urgently need to change the way we prescribe and use antibiotics, says medicines management expert Matt Griffiths.
medecine

Overuse of antibiotics can lead to antibiotic resistance. This is becoming a major problem worldwide, and we urgently need to change the way we prescribe and use antibiotics, says medicines management expert Matt Griffiths

Most upper respiratory tract infections are viral. As antibiotics are only effective if the infection is caused by bacteria, they are not recommended in most cases.

However, prescribing for respiratory tract infections in primary care is not an exact science, and deciding whether an infection is viral or bacterial is often down to individual clinicians.

National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries, such as Prodigy, can be used to aid diagnosis. Is the throat red? Is pus visible? Are lymph nodes raised? Does the patient have

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Overuse of antibiotics can lead to antibiotic resistance. This is becoming a major problem worldwide, and we urgently need to change the way we prescribe and use antibiotics, says medicines management expert Matt Griffiths

medicines
Care is needed to ensure antibiotics stay effective. Picture: Science Photo Library

Most upper respiratory tract infections are viral. As antibiotics are only effective if the infection is caused by bacteria, they are not recommended in most cases. 

However, prescribing for respiratory tract infections in primary care is not an exact science, and deciding whether an infection is viral or bacterial is often down to individual clinicians. 

National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries, such as Prodigy, can be used to aid diagnosis. Is the throat red? Is pus visible? Are lymph nodes raised? Does the patient have a pyrexia over 38.3°C? 

Diagnosis

A patient with a viral infection will often have a temperature, but this may subside after a few days. With bacterial infections, the high temperature will usually continue.

Throat swabs or blood tests can also be used for diagnosis, and the inflammatory marker C-reactive protein can be tested to see if it is raised.

A high CRP may rule out viral infection as sole aetiology, and bacterial infection and antibiotic treatment should be considered in these cases. 

Context

But a raised CRP could be related to other inflammatory causes so must be considered in the context of the clinical findings for each patient.

Although there are cost implications with CRP testing, it adds another valuable tool to our kit as practitioners, and is worth the investment.

Viral infections can be compounded at a later stage by bacterial infections, and I am not suggesting we stop prescribing antibiotics altogether. But if we are to reduce the public health risk and ensure the precious antibiotics we have are effective for a long time, we have to be very careful about their use


Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University 
 

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