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NICE working on guidelines on antibiotics for common infections

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For the first time, the National Institute for Health and Care Excellence is developing specific advice about when and how to prescribe antibiotics for conditions such as sore throats and colds.

Confirmation of the antimicrobial prescribing guideline programme follows a controversial journal article that argued that the deeply established “complete the course” message for antibiotics should be dropped.

“NICE is currently developing guidelines for managing common infections”

Sally Davies

The new series of 30 evidence-based guidelines will help nurses and doctors in the “battle against antimicrobial resistance” by preventing unnecessary use of the drugs, said the clinical regulator.

The first in the series on sinusitis – commonly known as a “stuffy nose” – has already been published in draft form, with final recommendations for due out towards the end of next month.

Early work is also underway on guidelines relating to sore throat and otitis media. In addition, guidance is planned for urinary tract infections, said the institute.

The new NICE guidelines will offer advice about whether the patient should receive antibiotics immediately, be given a delayed prescription or educated in how to self-manage their symptoms.

They will also suggest how long the course of treatment should last, noted the institute.

“This new suite of guidance will give quick and easy access to evidence-based advice on whether to prescribe antibiotics”

Fiona Glen

By using our antibiotics “wisely we can prolong their effectiveness”, it said, adding that it was thought that by 2050 up to 10 million people could die each year due to resistance “rendering our medicines useless”.

The institute said it would be working with Public Health England on the guidelines, which were requested by the Department of Health to “help slow development of antimicrobial resistances”.

Fiona Glen, programme director at NICE’s guideline development centre, said: “This new suite of NICE guidance will give healthcare professionals quick and easy access to evidence-based advice on whether to prescribe antibiotics.

“We hope it will reduce inappropriate prescribing, and therefore help to protect our antimicrobials against ever-increasing threats of resistance,” he said.

The NICE statement on its guidance appears to have been sparked by a recent claims in a leading medical journal that patients did not need to finish their course of antibiotics and could safely stop when they felt better.

“When guidelines are updated, they should take all new evidence into account”

Helen Stokes-Lampard

The message that patients should “complete the course” of antibiotics to avoid resistance was not backed by evidence and should be dropped, argued UK researchers in the British Medical Journal.

The article, by academics from Brighton and Oxford, also said patients were put at unnecessary risk from resistance when treatment was given for longer than necessary, not when it was stopped early.

They added that completing the course went against one of the “most fundamental and widespread medication beliefs”, which is that people should take as little medication as necessary.

But Professor Dame Sally Davies, chief medical officer for England, said: “The advice to the public remains the same – people should always follow the instructions of their healthcare professional.

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“NICE is currently developing guidelines for managing common infections, which will look at the evidence on appropriate prescribing of antibiotics,” she said.

“The Department of Health will continue to review all new evidence on prescribing and drug resistant infections, as we aim to continue the great progress we have made on tackling antimicrobial resistance at home and abroad,” she added.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, described resistance to antibiotics as “one of the biggest health challenges we face globally”.

“It’s important that we take new evidence around how to curb this on board – but we cannot advocate widespread behaviour change on the results of just one study,” she said.

But she highlighted that recommended courses of antibiotics were “not random” and were tailored to individual conditions.

In many cases, she noted that courses were quite short – for urinary tract infections, for example, three days was often enough to cure the infection.

“It’s important that patients have clear messages and the mantra to always take the full course of antibiotics is well known – changing this will simply confuse people,” said Professor Stokes-Lampard.

Antibiotic Research UK

NICE working on guidelines on antibiotics for common infections

Colin Garner

She added: “We agree that more high quality, clinical trials are needed – and when guidelines are updated, they should take all new evidence into account. But we’re not at that stage yet.”

Professor Colin Garner, chief executive of Antibiotic Research UK, said: “Whilst one can see sound scientific reasons to reduce antibiotic treatment periods, there is little scientific evidence to support this conclusion.

“Evidence-based medicine tells us that we should only alter how long antibiotics should be given for as a result of well conducted clinical trials,” he stated.

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Readers' comments (1)

  • Experiencing sinusitis is debilitating. I suffered for years, each episodes lasting weeks and the only remedy/relief was to take a course of antibiotics. Eventually I was operated on, which for the most part has been a success.
    Without antibiotics I would continue to suffer and be in extreme pain, causing me to take sick leave. This is reality, I know, I put myself through the test. I strongly believe in only take a course of antibiotics if absolutely necessary. For full blown is!

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