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NICE urges GPs not to prescribe antibiotics for bronchiolitis

GPs must avoid prescribing antibiotics to babies and young children with bronchiolitis, under a new NICE standard for managing the condition.

NICE said most cases of bronchiolitis – which is caused by a virus, usually respiratory syncytial virus – are mild and can be managed at home.

The standard states that ’children with bronchiolitis are not prescribed antibiotics to treat the infection' as 'the number of children who have bronchiolitis and who then develop a bacterial infection is extremely low'.

It adds: 'Antibiotics can lead to common adverse reactions. Reducing unnecessary antibiotics will help prevent the development of bacterial resistance and will also reduce costs.'

NICE said GPs should advise parents that bronchiolitis usually settles without the need for treatment, although cold remedies can be used to ease symptoms. Children’s breathing and feeding will usually get better within five days, although a cough can take up to three weeks to clear up.

Red flags that indicate serious complications include disrupted breathing, exhaustion or the skin inside the child’s lips turning blue.

Dr Maureen Baker, chair of the RCGP, said: ‘Bronchiolitis can be a very nasty illness for babies and young children - and very distressing and alarming for their parents.

‘But most babies and young children with bronchiolitis do not require antibiotics and this guidance will help reassure parents that in the majority of cases the condition can be effectively managed at home.

‘It will also support GPs and their teams who are working hard to reduce antibiotic prescribing so that they are only given to our younger patients when they really need them.’

Readers' comments (9)

  • "GUIDELINE"
    "MOST"
    "LOW"
    "MAJORITY"
    Over to the gp,absolutely no responsibility to NICE.
    get it wrong and you can reasonably expect professional damnation, and possibly to be hung.
    you can certainly expect to be persued by teams of litigants, equipped with google, and limitless time,for the rest of your natural life,supported enthusistically by the GMC
    If NICE have absolutely one drop of confidence in their own guideline ;make it a rule,issue fixed instructions, and take the responsibility

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  • Could this guideline be circulated within paediatric A&E depts??
    Seem this is where the majority of prescriptions arise in this situation!!

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  • In my career of 33 yrs as GP - Most that I have referred to hospital and discharged or come from a/e - all get antibiotics. Two fingers to nice.

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  • 'the number of children who have bronchiolitis and who then develop a bacterial infection is extremely low'.

    Oh yeah?! And who will NOT prescribe abx and risk that "extremely low" chance of bacterial infection which will potentially ruin you life via GMC? If the GMC looked at it as a risk worth taking for the greater good then no problems. The problem is the use of the retro scope and the manslaughter until proven innocent ( which never happens. Like some one said already, 2 fingers nice, 2 fingers GMC.

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  • NICE are a bunch of gutless has beens, I've actually asked several members of various NICE boards why they do not take any medic legal responsibility. They always pretend not to understand the concept.

    Even the possibility of offering support to GP's who have detrimental comments on their NHS choices website about antibiotic prescribing does not generate any interest. It would be easy for them to have a preset comment which practices could use in their reply.

    As usual real clinicians make real decisions - allow the charlatans to generate hot air!

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  • Nice is just money saving

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  • Even one case where the diagnosis turns out to be bacterial makes it harder to resist prescribing.The 'cause and effect' link between 'me prescribing too much amoxicillin for 'low'probability of benefit for bronchiolitis ', to the establishing of major quinolone -resistant pseudomonas or whatever , etc,seems so distant that it is not a strong enough motivation for practice change when you have one specific sick patient in front of you

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  • YES! But first review the procedures! A&E: aerosols + inhaled salbutamol, AND emergency respiratory physiotherapy, at the hospital then at home! AND fight against mites at home, AND Vitamine D AND iron supplementation if chronic ENT... And of course correct diagnostic! To do a correct diagnostic a minimum is a CXR and a FBC! Do not anymore send back home without treatment or some "paracetamol" the poor baby! Just a question: how many physio know how to make a baby spit, and to teach the mother to do it???
    Of course if not done, the British weather, possible bad housing, crowed homes, then the secondary chest infection is quasi systematic!!

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  • useless nice guidelines

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