When an immediate antibiotic prescription and/or further appropriate investigation is indicated

Depending on clinical assessment of severity, patients in the following subgroups can also be considered for an immediate antibiotic prescribing strategy (in addition to a no antibiotic or a delayed antibiotic prescribing strategy):

• bilateral acute otitis media in children younger than 2 years
• acute otitis media in children with otorrhoea
• acute sore throat/acute pharyngitis/acute tonsillitis when three or more Centor criteria are present
  
  
• an immediate antibiotic prescription and/or further appropriate investigation and management should only be offered to patients (both adults and children) in the following situations:
  • if the patient is systemically very unwell
  • if the patient has symptoms and signs suggestive of serious illness and/or complications (particularly pneumonia, mastoiditis, peritonsillar abscess, peritonsillar cellulitis, intraorbital and intracranial complications)
  • if the patient is at high risk of serious complications because of pre-existing comorbidity. This includes patients with significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis, and young children who were born prematurely
  • if the patient is older than 65 years with acute cough and two or more of the following criteria, or older than 80 years with acute cough and one or more of the following criteria:
    • hospitalisation in previous year
    • type 1 or type 2 diabetes
    • history of congestive heart failure
    • current use of oral glucocorticoids
  • For these patients, the no antibiotic prescribing strategy and the delayed antibiotic prescribing strategy should not be considered

Reference:

• (1) NICE (June 2008).Respiratory tract infections ? antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care