Antibiotic prescribing for self limiting respiratory tract infections in primary care: summary of NICE guidance

National Institute for Health and Clinical Excellence, Manchester M1 4BD.
BMJ (online) (Impact Factor: 17.45). 07/2008; 337(jul23 3):a437. DOI: 10.1136/bmj.a437
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    • "As the causal treatment of the common cold is difficult, the purpose of common cold treatment is relief of various symptoms. As symptoms are resolved in 7 to 10 days spontaneously, allopathy is usually adopted.6) Representative allopathic treatment includes prescription of non-steroidal antiinflammatory drugs (NSAIDs) and acetaminophen to resolve chills, muscle pain, headache, and fever.1) "
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    ABSTRACT: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used for common cold symptom relief. The objective of this study was to evaluate and compare the efficacy and safety of acetaminophen and NSAIDs in common cold symptom relief using meta-analysis of randomized controlled trial. We searched MEDLINE (PubMed), Cochrane, EMBASE, CINAHL, KMbase, KoreaMed, National Assembly Library, and Riss4u for studies released through June 2012. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. The Review Manager ver. 5.1 (RevMan) was used for statistics. We identified 5 studies. The relative benefit for participants with pain relief was 1.00 (95% confidence interval [CI], 0.96 to 1.05) and I(2) = 0%. The existence of the heterogeneity between studies was not important in this study, thus subgroup analysis was not implemented. The relative benefit for participants with rhinorrhea was 1.02 (95% CI, 0.77 to 1.35) and I(2) = 0%, which also indicates the existence of heterogeneity was not important. The relative risk of adverse events was 1.14 (95% CI, 0.93 to 1.40), I(2) = 0%. There was no apparent asymmetry in the funnel plot. There was no difference between NSAIDs and acetaminophen in common cold symptom relief.
    Full-text · Article · Jul 2013 · Korean Journal of Family Medicine
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    • "The number of randomized patients is still scarce and the results for some of the outcome are non conclusive. Nevertheless, some institutions such as NICE start to recommend it as an initial strategy for self-limiting respiratory tract infections [26]. "
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    ABSTRACT: Background Respiratory tract infections are an important burden in primary care and it’s known that they are usually self-limited and that antibiotics only alter its course slightly. This together with the alarming increase of bacterial resistance due to increased use of antimicrobials calls for a need to consider strategies to reduce their use. One of these strategies is the delayed prescription of antibiotics. Methods Multicentric, parallel, randomised controlled trial comparing four antibiotic prescribing strategies in acute non-complicated respiratory tract infections. We will include acute pharyngitis, rhinosinusitis, acute bronchitis and acute exacerbation of chronic bronchitis or chronic obstructive pulmonary disease (mild to moderate). The therapeutic strategies compared are: immediate antibiotic treatment, no antibiotic treatment, and two delayed antibiotic prescribing (DAP) strategies with structured advice to use a course of antibiotics in case of worsening of symptoms or not improving (prescription given to patient or prescription left at the reception of the primary care centre 3 days after the first medical visit). Discussion Delayed antibiotic prescription has been widely used in Anglo-Saxon countries, however, in Southern Europe there has been little research about this topic. The DAP trial wil evaluate two different delayed strategies in Spain for the main respiratory infections in primary care. Trial registration This trial is registered with, number http://NCT01363531.
    Full-text · Article · May 2013 · BMC Family Practice
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    • "Symptoms of AURTIs commonly include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure, and sneezing. Although the available evidence has shown that antibiotics probably provide little benefit for a large proportion of respiratory tract infections, antibiotics are still largely inappropriately used in clinic [3–5]. Antibiotic treatment to prevent suppurative and nonsuppurative complications may be inappropriate nowadays with generally low rates of major complications [3]. "
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    ABSTRACT: Acute upper respiratory tract infections (AURTIs) are the illnesses caused by an acute infection with various viruses and bacteria involving the upper respiratory tract. Shuanghuanglian (SHL) injection, a Chinese medicine intravenous preparation extracted from honeysuckle, Scutellaria baicalensis, and fructus forsythiae, is commonly used to treat AURTIs. Although it is used largely in Chinese hospitals, there is no substantial evidence to demonstrate its clinical effect on AURTIs. We conducted a systematic review to evaluate the effectiveness and safety of Shuanghuanglian injection for the treatment of acute upper respiratory tract infections.
    Full-text · Article · Mar 2013 · Evidence-based Complementary and Alternative Medicine
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