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More inWhite Papers  

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).”

It advises that 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.”

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

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