Managing patient expectations of antibiotics Managing patient expectations of antibiotics

29 June 2009

Health professionals are being given clear guidelines for prescribing particular antibiotics in different diagnostic scenarios in the latest National Prescribing Service (NPS) education program: Management of Specific Respiratory Tract Infections.

The therapeutic program aims to address inappropriate antibiotic use, particularly for treating acute bronchitis, sore throat and other respiratory tract infections, but also gives prescribers the facts to be confident when prescribing symptomatic treatments.

“Prescribing antibiotics for acute bronchitis continues, even though the illness is usually viral and antibiotics are only appropriate when a cough is the result of pneumonia or an exacerbation of chronic obstructive pulmonary disease (COPD),” NPS Deputy CEO, Karen Kaye said.

“GPs have told us they often feel pressured by patients to prescribe something but they aren’t confident to only recommend rest, saline solution, steam inhalation*, and analgesics if the patient has pain and fever,” Ms Kaye said.

Acute sore throat is usually viral and clinical features that distinguish a sore throat requiring antibiotics include fever over 38°C, exudate on the tonsils, tender cervical lymphadenopathy and the absence of cough. These features indicate infection by group A streptococcus and require antibiotics.

Management of specific respiratory tract infections reinforces the following:

• Antibiotics are only appropriate in acute cough if a chest X-ray suggests pneumonia or in exacerbations of chronic obstructive pulmonary disease (COPD) with sputum purulence, plus increased sputum volume and/or dyspnoea
• Antibiotics are only appropriate in sore throat if all four diagnostic criteria (fever, exudate, lymphadenopathy and absence of cough) for streptococcal infection are present
• Use penicillin V for 10 days in uncomplicated sore throat that appears to be streptococcal
• Reserve macrolides when treating respiratory tract infections for those with pertussis or those hypersensitive to penicillin
• Cough and cold medicines have limited efficacy
• Provide advice to patients on appropriate symptomatic relief.

“Home remedies such as honey and lemon, rather than a cough medicine which has limited efficacy, are the simplest and cheapest treatment options for uncomplicated acute coughs,” Ms Kaye said.

As part of the therapeutic program, NPS provides health professionals with:

• Case Study 58: Antibiotics and respiratory tract illness—thinking of patient-centred care
• GP Clinical Audit: Management of specific respiratory tract infections (enrol by 7 August 2009)
• Prescribing Practice Review 46: Management of specific respiratory tract infections
• NPS News 63: Managing expectations for antibiotics in respiratory tract infections

The GP clinical audit is recognised by the RACGP Quality Assurance & Continuing Professional Development Program (total points 40 in category 1) and in the ACRRM Professional Development Program (30 points in extended skills). It also qualifies as an activity for QPI of the PIP (Quality Prescribing Initiative of the Practice Incentives Program), for the year ending April 2010.

To enrol in the clinical audit visit www.nps.org.au/health_professionals.

_{*steam inhalation should not be used by children}

ENDS

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing.