Respiratory-tract-infections-full-guideline-apendices-draft2.doc

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DRAFT FOR CONSULTATION Respiratory tract infections: appendices DRAFT (March 2008 ) 6 Appendices 6.1 Appendix 1 – Scope 6.2 Appendix 2 – Key Clinical Questions 6.3 Appendix 3 – Search Strategy 6.4 Appendix 4 – Inclusion / Exclusion Criteria & Evidence Tables 6.5 Appendix 5 – Health Economic Evidence 6.6 Appendix 6 – Health Economic Evidence Tables 6. 1 Appendix 1 – Scope NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE 1 Guideline title Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care 1.1 Short title Respiratory tract infection – antibiotic prescribing 2 Background The National Institute for Health and Clinical Excellence (‘NICE’ or ‘the Institute’) will develop an optimal practice review on prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary Respiratory tract infections: appendices DRAFT (March 2008) 1 of 106
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DRAFT FOR CONSULTATION care. The guideline will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness. 3 Clinical need for the guideline a) Antibiotics are commonly prescribed in primary care for respiratory tract infections (RTIs) in both adults and children. General practice consultation rates in England and Wales show that a quarter of the population will visit their GP because of an RTIs each year. RTIs are the reason for 60% of all antibiotic prescribing in general practice, and this constitutes a significant cost to the NHS. The cost of acute cough alone, in terms of antibiotic prescribing costs, is greater than £15 million a year. b) There is good evidence that antibiotics offer little benefit in treating a large proportion of RTIs in adults and children in primary care. These RTIs include the common cold, sore throat, acute sinusitis, acute otitis media and acute bronchitis. These conditions are largely self-limiting, and complications are likely to be rare if antibiotics are withheld. The inappropriate prescribing of antibiotics has the potential to cause drug-related adverse events, to increase the prevalence of antibiotic resistant organisms in the community and to increase primary care consultation rates for minor illness. c) Three different antibiotic management strategies can be used to deal with RTIs within the primary care consultation: no antibiotic prescribing; delayed (or deferred) antibiotic prescribing (in which an antibiotic prescription is written for use at a later date should symptoms worsen) and immediate antibiotic prescribing. The decision negotiated between practitioner and patient depends on both the practitioner’s assessment of the risk of complications if antibiotics are withheld and on the patient’s expectations regarding an antibiotic prescription. Perceived advantages of delayed prescribing as a strategy over no prescribing are that it offers a ‘safety net’ for the small proportion of cases that develop into Respiratory tract infections: appendices DRAFT (March 2008) 2 of 106
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