NICE has continued to publish guidelines to support antimicrobial stewardship in terms of prescribing.

Acute otitis media

Guidelines published for acute ear infections (otitis media) detail the strategy aiming to limit antibiotic use and reduce antimicrobial resistance. The guidelines say that this self-limiting condition, which mostly affects children, usually gets better within three days without antibiotics. Pharmacists can help patients to manage symptoms and control pain in order to support prescribers and educate the patient/carer about when to seek medical support if the condition is worsening, no improvement is seen or the individual is systemically unwell. Amoxicillin remains the first-line treatment.

Lower urinary tract infection

NICE guidelines were also released with the aim of optimising antibiotic use for lower urinary tract infection in children, young people and adults who do not have a catheter. The guidelines include a table to support prescribing decisions offering advice on self-care and when to prescribe antibiotics or issue ‘backup’ antibiotic prescriptions. Backup antibiotics should be used if no improvement is seen within 48 hours or symptoms worsen. Nitrofurantoin and trimethoprim are first-line treatments in men and women, men receiving a seven-day course compared to three days for women.

Acute sore throat

NICE guidance on antimicrobial prescribing for acute sore throat aims to limit antibiotic use, as an acute sore throat is often triggered by a viral URT infection, which lasts for around a week. Antibiotics are not usually needed regardless of whether the infection is caused by bacteria or a virus, and not prescribing them will not usually lead to complications.

FeverPAIN or Centor scores are used to assess symptoms, with phenoxymethylpenicillin the first-line treatment where needed.

Strep A infection in sore throat

A NICE Medtech innovation briefing on point-of-care (PoC) diagnostic testing in primary care for group A beta-haemolytic streptococcus (strep A) throat infection covered 11 technologies. Evidence from five tests suggests that PoC testing is more helpful for diagnosing strep A infection than clinical scoring systems alone in people with acute sore throat.

The additional costs of the tests would increase costs of standard care in GP practice but this could be offset if their use reduced antimicrobial resistance and improved both patient satisfaction and education. If adopted in community pharmacy settings, it could lead to cost savings due to fewer GP appointments and less unnecessary antibiotic prescribing.