1、Information about NICE clinical guideline 69 1Issue date: July 2008Understanding NICE guidanceInformation for people who use NHS servicesUse of antibiotics for respiratory tract infections in adults and children This booklet is about the care and treatment of people with respiratory tract infections
2、 (RTIs) in the NHS in England and Wales. It explains guidance (advice) from NICE (the National Institute for Health and Clinical Excellence). It is written for adults and parents of children aged 3 months and older, but it may also be useful for families or carers or for anyone with an interest in t
3、he condition.The booklet aims to help you understand the care and treatment options that should be available in the NHS. It does not describe RTIs or the tests or treatments in detail. Your doctor or nurse practitioner should discuss these with you. There are examples of questions you could ask thro
4、ughout this booklet to help you with this. Some sources of further information and support are on page 10.NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments they should receive. Information about NICE clinical guideline 69 2ContentsYo
5、ur care 3Respiratory tract infections (RTIs) 5More information 10About NICE 11The advice in the NICE guideline covers: adults and children (3 months and older) who see their GP or nurse practitioner because of a respiratory tract infection.It does not specifically look at: further care for adults an
6、d children (3 months and older) who need investigations and/or immediate antibiotics. Information about NICE clinical guideline 69 3Your careYour treatment and care should take into account your personal needs and preferences, and you have the right to be fully informed and to make decisions in part
7、nership with your healthcare team. To help with this, your healthcare team should give you information you can understand and that is relevant to your circumstances. All healthcare professionals should treat you with respect, sensitivity and understanding and explain RTIs and the treatments simply a
8、nd clearly.The information you get from your healthcare team should include details of the possible benefits and risks of particular treatments. You can ask any questions you want to and can always change your mind as your treatment progresses or your condition or circumstances change. Your own pref
9、erence for a particular treatment is important and your healthcare team should support your choice of treatment wherever possible, but this does depend on your age. If you are over 16, or under 16 and fully understand the treatment, you may be able to give your own agreement. If you are too young, y
10、our parents or carers may need to agree to your treatment.Your treatment and care, and the information you are given about it, should take account of any religious, ethnic or cultural needs you may have. It should also take into account any additional factors, such as physical or learning disabiliti
11、es, sight or hearing problems, or difficulties with reading or speaking English. Your healthcare team should be able to arrange an interpreter or an advocate (someone who supports you in putting across your views) if needed.If people are unable to understand a particular issue or are not able to mak
12、e decisions for themselves, healthcare professionals should follow the advice that the Department of Health has produced about this. You can find this by going to the Department of Health website Information about NICE clinical guideline 69 4(www.dh.gov.uk/consent). Your healthcare professional shou
13、ld also follow the code of practice for the Mental Capacity Act. For more information about this, visit www.publicguardian.gov.uk.Information about NICE clinical guideline 69 5Respiratory tract infections (RTIs)Infections such as ear infections, sore throat, sinusitis, cough and the common cold are
14、widespread. Doctors often use the term respiratory tract infection (RTI) to include any or all of these infections.Most RTIs are caused by a virus and clear up on their own. Viruses cannot be killed by antibiotics only bacterial infections can be effectively treated with antibiotics.Each viral infec
15、tion you get is caused by a slightly different virus, and once youve fought it off, you are immune (resistant) to that particular virus.Typical total duration of an RTI Ear infection: 4 days Sore throat: 1 week Common cold: 1 weeks Sinusitis: 2 weeks Cough: 3 weeks First appointment When you first s
16、ee the doctor or nurse practitioner (a nurse with specialist training who can prescribe some medications), he or she should ask about your symptoms, what medicines or treatments you have been taking, your medical history and whether you have any other medical conditions that might be important. The
17、doctor or nurse practitioner may examine you. For example, he or she may listen to If you think that your care does not match what is described in this booklet, please talk to a member of your healthcare team.Information about NICE clinical guideline 69 6your chest through a stethoscope or look in y
18、our ears through an otoscope.The doctor or nurse practitioner should ask about your own concerns and expectations when talking to you about whether antibiotics are needed.If you have an RTI that is expected to clear up on its own, you should be offered either a delayed prescription for antibiotics o
19、r no prescription at all. The rest of this booklet tells you more about RTIs and when antibiotics work best.No antibioticsIf you have not been offered antibiotics, this is because your RTI should clear up on its own. See page 5 for more information on how long RTIs usually last and page 10 for more
20、information on how you can help relieve the symptoms.You should be reassured that antibiotics are not necessary immediately because they will not help your symptoms. In addition, antibiotics can cause unpleasant side effects, such as sickness, diarrhoea or skin rashes. You should make another appoin
21、tment if your infection gets worse or lasts for longer than expected. Delayed antibioticsYou may be offered a delayed prescription for antibiotics. This will either be a prescription that you take to the chemist at a later date if your symptoms do not improve or get worse, or a prescription that you
22、 collect at a later date from a convenient location (for example, the surgery reception). If you are offered a delayed prescription, this is because your RTI should clear up on its own. See page 5 for more information on how Information about NICE clinical guideline 69 7long RTIs usually last and pa
23、ge 10 for more information on how you can help relieve the symptoms. You should be reassured that antibiotics are not needed immediately because they will not help your symptoms. In addition, antibiotics can cause unpleasant side effects, such as sickness, diarrhoea or skin rashes. You should use th
24、e delayed prescription if your symptoms are not starting to go away or if you start to feel worse. You should make another appointment if your symptoms get worse despite using the delayed prescription.Questions you might like to ask When should I start to feel better and what should I do if I dont s
25、tart to feel better by then? Is there anything I can do to help myself get better? When and how should I seek further help? Is there any written material (like a leaflet) that I can have?Immediate antibioticsYour doctor or nurse practitioner can also offer an immediate prescription for: children who
26、 are younger than 2 years with an ear infection (called acute otitis media) that affects both ears children who have both acute otitis media and discharge from the ear people with severe sore throat who have swollen lymph nodes, discharge on their tonsils and fever.Information about NICE clinical gu
27、ideline 69 8Immediate antibiotics for people at risk of complicationsYou may be offered an immediate prescription for antibiotics or further checks or investigations if: you are very unwell you have signs or symptoms of serious illness or complications (especially pneumonia, an infection of the mast
28、oid bone behind the ear called mastoiditis, a complication of tonsillitis called a peritonsillar abscess, or problems that affect the bones of the head) you have another medical condition that makes you more at risk of a complication from the RTI, for example heart, lung or kidney disease, neuromusc
29、ular disease (such as muscular dystrophy), cystic fibrosis or if your immune system has been weakened (for example by immunosuppressive medicines used after a transplant or in cancer therapy). Young children who were born prematurely are also more at risk of a complication. you are older than 65 yea
30、rs and have a cough and two or more of the following, or if you are older than 80 years and have a cough and one or more of the following:o you have been admitted to hospital in the past yearo you have diabeteso you have a history of congestive heart failureo you are taking steroid medicines.See pag
31、e 5 for more information on how long RTIs usually last and page 10 for more information on how you can help relieve the symptoms. Information about NICE clinical guideline 69 9Questions you might like to ask When should I start to feel better and what should I do if I dont start to feel better by th
32、en? What should I do if I get any side effects from the antibiotics? Are there any foods or drinks that I should avoid? Is there anything I can do to help myself get better? When and how should I seek further help?Information about NICE clinical guideline 69 10Managing symptomsYou can take paracetam
33、ol or ibuprofen to relieve headache, aches and pains and fever.You may also wish to ask your pharmacist for advice about over-the-counter remedies such as cough medicines, decongestants or throat pastilles.If you are taking medicines for any other condition it is important to check with your doctor
34、or pharmacist before you take any over-the-counter remedies. Remember always check the instructions on the bottle or packet and never take more than the recommended dose. If you are not sure, ask your doctor, nurse practitioner or pharmacist for help and advice.More informationNHS Direct online (www.nhsdirect.nhs.uk) may be a good starting point for finding out more. Your local Patient Advice and Liaison Service (PALS) may also be able to give you further information and support.
