Respiratory Tract Infections – NICE guidelines 2009

No Antibiotics or Delayed Antibiotics Prescribing for…

  • Acute Otitis Media
  • Acute sore throat / acute pharyngitis / acute tonsillitis
  • Common Cold
  • Acute Rhinosinusitis
  • Acute cough / acute bronchitis

Consider Immediate Antibiotic Prescribing for…

  • Children younger than 2 yrs with bilateral acute otitis media
  • children with otorrhoea who have acute otitis mediea
  • Patients with acute sore throat / acute pharyngitis / acute tonsilitis when 3 or more Centor 

Centor Criteria:

  1. Presences of Tonsillar Exudate
  2. Tender anterior cervical lymphadenopathy or lyphadenitis
  3. History of Fever
  4. Absence of cough

NB If 3 or more of the Centor Criteria are present then they have a 40-60% chance that the sore throat is caused by Grout A beta-haemolytic Strep 

Recommended Immediate Antibiotic Prescribing for..

  • Patients systemically very unwell


  • Symptoms / signs suggestive of serious illness and/or complications such as…
    • pneumonia
    • mastoiditis
    • peritonsillar abscess
    • peritonsillar cellulitis
    • intraorbital or intracranial complications


  • Those at high risk of serious complications in view of pre-existing comorbidity 
    • patiens with significant heart / lung / renal / liver / neuromuscular diasease
    • immunosuppression
    • cystic fibrosis
    • young children who were born prem


  • Older than 65years with acute cough and two of the following or
  • Or Older than 80years with acute cough and one or more of the following
    • Hospitalisation in the previous year
    • type 1 or type 2 diabetes
    • History of congestive heart failure
    • Current use or oral glucocorticoids

Also Tell Patients How Long it will last for!

  • Acute otitis media: 4 days
  • Acute sore throat / acute pharyngitis / acute tonsillitis: 1 week
  • Common cold: 1.5 weeks
  • Acute rhinosinusitis: 2.5 weeks
  • Acute cough / acute bronchitis: 3 weeks.