Quality standard

Quality statement 3: Antibiotic duration

Quality statement 3: Antibiotic duration

Quality statement

Adults prescribed an antibiotic for an acute respiratory infection are given a 5‑day course, or 5 to 10 days if phenoxymethylpenicillin is prescribed for acute sore throat.

Rationale

When a decision is made to prescribe antibiotics for acute respiratory infection, the shortest course that is likely to be effective should be prescribed to reduce the risk of antimicrobial resistance and adverse effects. This will be a 5‑day course or 5 to 10 days if phenoxymethylpenicillin is prescribed for acute sore throat (5 days may be enough for symptomatic cure for acute sore throat but 10 days may increase the chance of microbiological cure for example, where there is recurrent infection). All people taking antibiotics should be reassessed if symptoms worsen rapidly or significantly, or do not start to improve within 3 days of taking the antibiotic.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of antibiotic courses prescribed for community-acquired pneumonia, acute cough, acute sore throat or acute sinusitis that are for 5 days (or up to 10 days if phenoxymethylpenicillin for sore throat).

Numerator – the number in the denominator that are for 5 days (or up to 10 days if phenoxymethylpenicillin for sore throat).

Denominator – the number of antibiotic courses prescribed for community-acquired pneumonia, acute cough, acute sore throat or acute sinusitis.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from electronic patient records. For measurement purposes, it may be appropriate to exclude groups with long-term conditions that require antibiotics for a longer duration (for example, bronchiectasis) based on local antimicrobial prescribing guidelines. NHS England's optimising antimicrobial use dashboard includes data on prescribing duration for specific antibiotics that can be used to treat acute respiratory infection in primary care. Results can be compared across different localities and age groups, however, the indication for use is not reported.

What the quality statement means for different audiences

Service providers (such as general practice, acute respiratory infection hubs, urgent treatment centres, virtual wards and hospitals) ensure that healthcare professionals prescribing antibiotics to treat acute respiratory infection are aware that the shortest effective course is usually 5 days except when prescribing phenoxymethylpenicillin as the first-choice oral antibiotic for sore throat (5 to 10 days).

Healthcare professionals (such as GPs, community pharmacists, nurse practitioners, advanced care practitioners, advanced paramedics and hospital clinicians) prescribe a 5‑day course of antibiotics to treat acute respiratory infection or 5 to 10 days if prescribing phenoxymethylpenicillin for acute sore throat (5 days may be enough for symptomatic cure but 10 days may increase the chance of microbiological cure for example, where there is recurrent infection). They give advice on possible adverse effects of the antibiotics and when to seek medical help. They also advise people to seek further help if their symptoms do not show signs of improving after 3 days of antibiotic therapy.

Commissioners ensure that they commission services that follow best practice guidance on antimicrobial stewardship.

Adults with an acute respiratory infection receive a short (usually 5‑day) course when prescribed an antibiotic.

Definitions of terms used in this quality statement

Acute respiratory infection

An acute illness (present for 21 days or less) affecting the respiratory tract with symptoms such as cough, sore throat, fever, sputum production, breathlessness, wheeze or chest discomfort or pain, and no alternative explanation. [NICE's guideline on acute respiratory infection in over 16s, terms used in this guideline section]

Equality and diversity considerations

Commissioners should work with providers to tackle higher antibiotic prescribing rates in more deprived areas. Prescribing targets should reflect the needs of the local population.