Antibiotic Awareness : Why it matters?
Antibiotics when used in a targeted way saves lives however there are unintended consequences of
antimicrobial use when not used judiciously which include:
selection of pathogenic organisms leading to health-care associated infections such
as Clostridium difficile
emergence of resistance
In South Staffordshire, Stafford &surrounds and Cannock Chase CCG have one of the highest
rates of antibiotic prescribing and also have high rates of broad spectrum antibiotics antibiotic
prescribing which is linked to increased incidence of C. Difficile rates in the community and hospital.
What is the focus?
It is estimated that approximately 80% of all antibiotic prescribing occurs in primary care , of which
50-60% may be unnecessary for upper respiratory tract infection or other minor self-limiting
conditions.
Our focused message to primary care is to “Target” antibiotics where it is needed and stick to the
local primary care antimicrobial guidance .
To achieve this we are promoting the NICE guidance for upper respiratory infections
. NICE state that most of upper
http://guidance.nice.org.uk/CG69/QuickRefGuide/pdf/English
respiratory infections such as those listed below are generally self-limiting and complications are
likely to be rare if antibiotics are not prescribed
Key focus for primary care are:

Explaining the natural history and duration of symptoms for adults and children over
3 months presenting with the following conditions :
Otitis media : 4 days
Acute Sore throats : 1 week
Acute coughs/bronchitis: 3 weeks
Acute rhinosinusitis: 2 and half weeks
Common cold: 1 and half week

If a patient presents at a GP practice with these conditions, the patient will be
assessed and encouraged to self care and no antibiotics or negotiate delayed antibiotic
strategy. The key focus is addressing patients concerns and expectations with supporting
leaflets (RCGP antibiotic leaflet or “When should I worry” and supporting better self
management.

We are also discouraging telephone prescribing for antibiotics.
As community pharmacists you are very important in supporting and empowering patients to
“Self care and take care” especially reiterating the natural history of the above conditions, and
supporting self management with rest OTC medicines etc. It is also important to make real to
patients the public heath threat and individual consequences of development of antibiotic
resistance with unnecessary use.
Who should we be extra careful with ?
Criteria for further investigation/referral :
However there will be some people that you will need to be extra careful with:

If patient is systemically unwell

Has symptoms and signs suggestive of serious illness/ complication

Is at high risk of serious complications because of pre existing co-morbidities (heart
lung, neuromuscular, immunosuppression, young children born premature)

Is older then 65 years with acute cough with two or more of the following criteria
or older then 80 years with acute cough with one of the following criteria:
-hospitalisation in previous year
-type 1 or type 2 diabetes
-history of congestive disease

If symptoms have persisted for more then 3 to 4 weeks
Green phlegm and snot is not always a sign of an infection needing antibiotics!
One of the main concerns patients and health professionals have is when there is green phlegm and
cough and decision point for referral and action.
Who does need antibiotics with green phlegm and cough.
For some patients green phlegm is a clinically important symptom such as :
 If a patient has chronic obstructive pulmonary disease (COPD) with green phlegm they
should be referred to their doctor/nurse or self management plan as they may have an
infection. People with COPD are more likely to be/have been smokers and green phlegm
in this group is more indicative of a sign of infection.
 if the patient has symptoms and signs suggestive of serious illness and/or complications
(particularly pneumonia)
 Those who are older (over 65 years) or who have other chronic lung and heart conditions
may need to seek advice about treatment.
Who doesn’t need antibiotics just because they have yellow or green phlegm?
 Otherwise healthy non-smoking individuals with no underlying health problems who have an
acute cough with phlegm of any colour (including yellow and green).
 A patient who is a smoker who has a cough and phlegm but with no diagnosis of chronic
obstructive pulmonary disease (COPD).
 Any adult or a child with asthma who has a cough with phlegm.
 Adults or children with a cough and green nasal discharge.
“ Preserve the miracle of antibiotics for yourself and for future generations!”
Ms Sharuna Reddy