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a throat lozenge imageJanuary 26 2018

New NICE guidance on managing an acute sore throat says antibiotics should not be prescribed for the majority of cases. Advising on self-care options, NICE promotes oral analgesics and maintaining adequate fluid intake over throat lozenges.


The guidance comes in NG84 ‘Sore throat (acute): antimicrobial prescribing’, which is intended for adults and children over the age of 5 years. It says that acute sore throat (including pharyngitis and tonsillitis) is self-limiting, and that “symptoms can last for around one week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).”

The FeverPAIN or Centor diagnostic criteria should be used to identify patients who are more likely to benefit from an antibiotic. However, for the majority, it will be a case of giving advice about the likely course of acute sore throat lasting a week, and on how to manage the symptoms of pain, fever and dehydration.

In terms of self-care advice, NICE says:

  • consider paracetamol for pain or fever, or if preferred and suitable, ibuprofen;
  • advise about the adequate intake of fluids;
  • explain that some adults may wish to try medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic. However, they may only help to reduce pain by a small amount;
  • be aware that no evidence was found on non-medicated lozenges, mouthwashes, or local anaesthetic mouth spray used on its own.

“In a 2011 survey of UK primary care (Gulliford et al. 2014), consultations for ‘sore throat’ accounted for 27% of all consultations for respiratory tract infections, and the median practice issued an antibiotic prescription for 60% of these,” said NICE.

Professor Gillian Leng, deputy chief executive at NICE, commented: “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, RCGP Chair, said: “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 TARGET Antibiotics toolkit, developed by the RCGP and Public Health England, is available to support GPs and other healthcare professionals in the appropriate prescribing of antibiotics.

Links:
NICE announcement     
NICE NG84 ‘Sore throat (acute): antimicrobial prescribing’. January 2018 
FeverPAIN and Centor diagnostic criteria (as defined in NG84)   
RCGP comment            

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