The National Institute for Health and Clinical Excellence (NICE), has issued guidance for prescribing antibiotics for self-limiting respiratory tract infections (RTI) in adults and children in primary care.

The guideline provides a care pathway which advises on when a no antibiotic or delayed antibiotic prescribing strategy is appropriate, and, consideration of an immediate prescribing strategy for other situations.

A no antibiotic prescribing strategy or a delayed antibiotic prescribing strategy should be agreed for patients with the following conditions:

- acute otitis media

-  acute sore throat/acute pharyngitis/acute tonsillitis

- common cold

- acute rhinosinusitis

- acute cough/acute bronchitis.

Depending on clinical assessment of severity, patients in the following subgroups can 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 co-morbidity. 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