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Antibiotic prescribing for upper respiratory tract infections: NICE guidelines
  1. Nee Na Kim1,
  2. Dilshad Marikar2
  1. 1 Department of Neurology, Great Ormond Street Hospital, London, UK
  2. 2 Paediatric Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to Dr Dilshad Marikar, Paediatric Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK; dilshad.marikar{at}

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The National Institute for Health and Care Excellence (NICE) published guidelines on prescribing antibiotics in acute sinusitis (October 2017)1 and acute sore throat (January 2018).2 The guidelines aim to reduce unnecessary microbial prescription that may lead to adverse effects and bacterial resistance.

When to prescribe antibiotics?

  • When the child is systemically unwell, has signs and symptoms of more serious illness or is at high risk of complications.

  • For acute sore throat, use FeverPain or Centor criteria (box 1) to identify those who are more likely to benefit from an antibiotic (table 1).

  • Consider a backup prescription for acute sinusitis where symptoms persist for 10 days or more without improvement, taking into account that although there are factors that might make a bacterial cause more likely (box 2), withholding antibiotics is unlikely to lead to complications and make little difference to duration or severity of symptoms.3

  • For inpatient management where you suspect sepsis, intraorbital/periorbital complications or intracranial complications.

Box 1

FeverPAIN and Centor Criteria

FeverPAIN criteria

  • Fever (during previous 24 hours).

  • Purulence (pus on tonsils).

  • Attend rapidly (within 3 days after onset of symptoms).

  • Severely Inflamed tonsils.

  • No cough or coryza (inflammation of mucous membranes in the nose).

Each of the FeverPAIN criteria score one point (maximum score of …

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  • Contributors Both authors contributed equally to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Patient consent for publication Not required.