Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care

London: National Institute for Health and Clinical Excellence (NICE); 2008 Jul.


Respiratory tract infection (RTI) is defined as any infectious disease of the upper or lower respiratory tract. Upper respiratory tract infections (URTIs) include the common cold, laryngitis, pharyngitis/tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Lower respiratory tract infections (LRTIs) include acute bronchitis, bronchiolitis, pneumonia and tracheitis. Antibiotics are commonly prescribed for RTIs in adults and children in primary care. General practice consultation rates in England and Wales show that a quarter of the population will visit their GP because of an RTI each year (Ashworth et al. 2005). RTIs are the reason for 60% of all antibiotic prescribing in general practice, and this constitutes a significant cost to the NHS. Annual prescribing costs for acute cough alone exceed £15 million (Lindbaek 2006).

There is evidence from randomised placebo-controlled trials (RCTs) that antibiotics have limited efficacy in treating a large proportion of RTIs in adults and children (see section 2). These include acute otitis media (AOM), acute cough/acute bronchitis, acute sore throat/acute pharyngitis/acute tonsillitis, acute rhinosinusitis and the common cold. These conditions are largely self-limiting and complications are likely to be rare if antibiotics are withheld. Therefore, these five common RTIs are the focus of this guideline. The inappropriate prescribing of antibiotics has the potential to cause drug-related adverse events, escalate the prevalence of antibiotic-resistant organisms in the community and increase primary care consultation rates for minor illness (Standing Medical Advisory Committee 1998).

Publication types

  • Review