GPs should cut back on antibiotic prescriptions for sore throats, NICE says

GPs should advise most patients with sore throats to use paracetamol rather than prescribing antibiotics, NICE has said.

NICE’s new guidance on managing sore throats says that most sore throats are caused by viral infections, however research suggests that antibiotics are prescribed in 60% of cases.

Of all GP appointments made in the UK for respiratory tract infections, 27% are for sore throats. NICE said that most people with a sore throat will feel better after one week, regardless of whether they have taken antibiotics, and patients should be advised to manage their symptoms with pain relief, such as paracetamol or ibuprofen.

The guidance is part of a series of advice on antimicrobial prescribing for managing common infections from NICE, which has been developed with Public Health England. NICE issued similar advice last year for sinusitis.

When to prescribe antibiotics

The guidance advises GPs to use the FeverPAIN or Centor criteria to identify people who are more likely to have a bacteria-induced sore throat.

For those with a FeverPAIN score of 2 or more, GPs should consider not prescribing or issuing a back-up prescription. For those with a FeverPAIN score of 4 or 5 or a Centor score of 3 or 4, GPs should consider an immediate antibiotic prescription or a back-up prescription.

Patients who are systemically very unwell, have symptoms of a more serious condition or are at high-risk of complications should be prescribed antibiotics straight away and further investigations ordered if required.

If patients have an acute sore throat associated with a severe systemic infection or severe suppurative complications they should be referred to hospital.

Children under 5 who present with a sore throat and fever should be assessed and managed as outlined in NICE's guidance on fever in under 5s.

NICE recommends phenoxymethylpenicillin as the first choice antibiotic for sore throats. For those with a penicillin allergy, clarithromycin or erythromycin should be used.

Antibiotic resistance

Professor Gillian Leng, deputy chief executive at NICE, said: ‘The evidence shows antibiotics are not an effective treatment for the majority of sore throats. People who need them should be given them, and our advice will support those decisions. But it is clear that routine prescribing in all cases isn’t appropriate.

'We are living in a world where bacteria are becoming resistant to antibiotics. It is vital these medicines are protected, and only used when they are effective.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: ‘Respiratory tract infections or sore throats, can make you feel rotten, and GPs understand our patients wanting access to something that will make them feel better, but in the majority of cases this won’t be – and shouldn’t be – antibiotics.

‘We support the NICE recommendation today that paracetamol or ibuprofen would be the most appropriate first line treatment to manage the pain caused by a sore throat.

‘Antibiotics are essential drugs but the bacteria causing infections are increasingly becoming resistant to them, and when that happens they cease to work. We must use them sparingly and only when they are appropriate in order to help curb this dangerous and global trend – and we need our patients’ help with this by them understanding that antibiotics are not a cure for every ill.

‘The RCGP has worked with Public Health England to develop the TARGET Antibiotics toolkit to support GPs and other healthcare professionals in the appropriate prescribing of antibiotics.’

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