The
management of common infections in primary care
Volume 17 Number 3
December 2006
Summary
This
Bulletin looks at the management of common
infections in primary care. It considers which patients
are likely to benefit from antibiotic treatment, either
because their symptoms are probably due to bacterial
infection rather than viral infection, or because they
are at risk of complications from the infection. The
evidence to support antibiotic treatment, symptomatic
treatment and delayed prescriptions is discussed.
The
Bulletin is in several parts, each of which
can be downloaded separately as print-friendly documents:
The
key
points from each document are also available
in one print-friendly document, which can be downloaded
and used as a reminder. |
Introduction
Widespread
use of antibiotics is associated with the emergence of resistant
bacteria, many of which are multi-drug resistant. Antibiotic
resistance is a threat to public health, especially for immunocompromised,
debilitated and elderly patients, because it can:1,2
- increase
the length and severity of illness
- increase
the spread of disease
- lead
to the use of alternative drugs with lesser known, or poorer
safety profiles
- increase
the financial cost of treatment and care.
Careful
prescribing of antibiotics may help to delay the development
and spread of antibiotic resistance.3
Health professionals have a responsibility to use antibiotics
appropriately.3 Prescribing
for viral or mild, self-limiting infections such as coughs
and colds is unlikely to improve the course of the illness,
puts patients at risk of unnecessary adverse reactions (e.g.
vomiting, diarrhoea, rash, fungal infection)3
and encourages further consultations.4
Clinicians need to be able to select the patients who are
at higher risk of complications and those who are more likely
to have a bacterial cause for their symptoms. This Bulletin
discusses which clinical signs and symptoms help to predict
the patients who are most likely to benefit from antibiotic
therapy (see Table), and looks at the evidence
for the effectiveness of antibiotics and symptomatic treatments.
Table:
Antibiotics should be targeted at those patients who
are most likely to benefit from therapy, for example
when:
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- a
usually self-limiting infection has not resolved in
a few days and/or
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- the
antibiotic will significantly shorten the duration
or severity of the illness and/or
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- the
patient is at high risk of complications (e.g. is
systemically unwell).
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Patients’
expectations, real or perceived, can influence antibiotic
prescribing.3 The risks and
benefits of immediate or delayed antibiotics, and symptomatic
treatment should be discussed with the patient and their views
taken into account. The Bulletin considers the evidence
for prescribing strategies and practical measures to educate
and involve patients (e.g. information leaflets, delayed prescriptions).
References
-
UK antimicrobial resistance strategy and action plan. London:
Department of Health; 2000. Accessed from www.dh.gov.uk
on 30/10/2006
-
National Prescribing Centre. Antibiotic resistance and prescribing
practice. MeReC Briefing 2003;21:1–8. Accessed from
www.npc.co.uk/merec.htm
on 30/10/2006
- Standing
Medical Advisory Committee sub-group on antimicrobial resistance.
The path of least resistance. London: Department of Health;
2000. Accessed from www.dh.gov.uk
on 30/10/2006
- Little
P, Gould C, Williamson I, et al. Pragmatic randomised controlled
trial of two prescribing strategies for childhood acute
otitis media. BMJ 2001;322:336–42
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National Institute for Health and Clinical Excellence (NICE)
is associated with MeReC Publications published by the NPC
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Email: copyright@npc.nhs.uk
Copyright 2006
National
Prescribing Centre, The Infirmary, 70 Pembroke Place, Liverpool,
L69 3GF Tel: 0151 794 8146 Fax: 0151 794 8139
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