Upper respiratory tract

Usually self-limiting illness with 80% resolving within 14 days. Antibiotics usually make little difference to symptom duration and/or improvement.

Optimise analgesia

Consider nasal corticosteroid in adults and children >12 years old 

Refer to: NICE/CKS Acute sinusitis

Symptoms for ≤10 days

No antibiotic

Symptoms with no improvement >10 days

A bacterial cause may be more likely if:

• Discoloured or purulent nasal discharge
• Severe localised pain (often unilateral and localised over teeth and jaw)
• Fever >38°C
• Significant worsening after an initial milder phase

First line 

No antibiotic

Consider delayed antibiotic prescribing OR immediate antibiotic if bacterial cause may be more likely

      Amoxicillin dose

      Penicillin Allergy:
            >12 years old: Doxycycline dose
            <12 years old: Clarithromycin dose
            Pregnant: Erythromycin dose

Second line (if no improvement after 2-3 days of first line antibiotic)

      Co-amoxiclav dose

      Penicillin Allergy: Co-trimoxazole dose

Duration: 5 days

Systemically very unwell, symptoms and signs of more serious illness/conditions, or high risk of complications (where hospital admission is NOT indicated)

Refer to hospital if:

• Severe systemic infection or sepsis
• Intra-orbital or periorbital complications
• Intra-cranial complication

Co-amoxiclav dose

Penicillin Allergy:
      >12 years old: Doxycycline dose
      <12 years old: Clarithromycin dose
      Pregnant: Erythromycin dose

Duration: 5 days

Usually self-limiting. By day 7 most (90%) cases will resolve without antibiotics

Use FeverPAIN score to assess likelihood of streptococcal sore throat. There is no validated scoring system for use in children under 3 years of age

Throat swabs should be sent before starting antibiotics if an individual is being treated for a likely Streptococcal sore throat, in case of failure to respond to antibiotics.

Routine throat swabs are NOT recommended in most other clinical situations. They have poor sensitivity and cannot differentiate between infection/carriage. For situations where they may apply, see NICE/CKS: How do I diagnose the cause of a sore throat?.

For cases where antibiotics are required

e.g. FeverPAIN score = 4 - 5, throat swab positive for Group A (C or G) Streptococcus isolated from throat swab

Children:

Refer to: Hospital: Paediatrics (Respiratory Tract - Upper, Tonsillitis)

Adults:

Phenoxymethylpenicillin dose
Duration: 5 - 10 days
Five days of phenoxymethylpenicillin may be enough for symptomatic cure, but a 10-day course may increase the chance of microbiological cure.

Penicillin Allergy: Clarithromycin dose
Duration: 5 days

Refer to: NICE Guidance: Sore throat (acute): antimicrobial prescribing

Children:

Refer to: Hospital: Paediatrics (Respiratory Tract - Upper, Tonsillitis)

Adults:

Phenoxymethylpenicillin dose
Duration: 10 days

Penicillin Allergy: Clarithromycin dose (Pregnant: Erythromycin dose)
Duration: 10 days

Refer to: NICE/CKS Scarlet Fever