CPD: APPROPRIATE ANTIBIOTIC USE FOR RESPIRATORY INFECTIONS


Learning objectives


After reading this article, pharmacists should be able to:


Recognise when antibiotics are unlikely to benefit patients with respiratory infections


Identify patients who require further assessment or referral


Support antimicrobial stewardship through effective communication and safety-netting


As winter approaches, community pharmacies across Northern Ireland will see an increase in patients presenting with coughs, colds, sore throats and other respiratory infections. Pharmacy teams are ideally placed to provide timely advice, support self-care and identify patients who may require further assessment, while helping to ensure antibiotics are used appropriately.


Understanding respiratory infections


Most uncomplicated respiratory tract infections are viral and self-limiting, meaning antibiotics will not speed recovery. Antibiotics provide limited benefit for conditions such as acute cough, sore throat and sinusitis, while exposing patients to potential adverse effects and contributing to antimicrobial resistance (AMR).


An acute cough can commonly last for three to four weeks and patients should be advised of this expected duration to help manage expectations. Northern Ireland’s endorsed antimicrobial prescribing guidance, based on NICE recommendations, advises that antibiotics should not routinely be offered for acute cough associated with an upper respiratory tract infection or acute bronchitis in people who are not at increased risk of complications. The Northern Ireland Formulary and current antimicrobial prescribing guidance provide important resources to support appropriate decision-making.


Assessing patients in practice


A structured consultation can help pharmacists distinguish self-limiting infections from presentations requiring further assessment. Important considerations include:


• Duration and progression of symptoms • Presence of fever or systemic illness • Breathlessness or chest pain • Relevant underlying conditions • Frailty or immunosuppression • Previous antibiotic use


• Symptoms suggesting a serious alternative diagnosis


For a sore throat, clinical scoring assessment tools such as FeverPAIN or Centor can help identify patients who are more likely to benefit from antibiotic treatment.


With sinusitis, symptoms present for around 10 days or less are generally unlikely to require antibiotics. Pharmacists should consider the overall clinical picture rather than relying on individual symptoms, such as coloured sputum or nasal discharge, as evidence of bacterial infection.


Communicating the decision


Patients may expect an antibiotic because they have previously received one for similar symptoms or believe antibiotics will shorten their illness. Simply telling a patient that an antibiotic is not required may leave them feeling that their concerns have not been addressed. Pharmacists can instead explain the likely cause and expected duration of the illness while offering a positive management plan.


Effective communication includes:


• Acknowledging the patient’s symptoms and concerns


• Explaining why an antibiotic is unlikely to help


• Providing practical advice on symptom management


• Explaining the expected duration of symptoms • Checking the patient’s understanding • Providing clear safety-netting advice


This approach reinforces that not prescribing an antibiotic is a clinical decision, rather than a lack of treatment.


When antibiotics are appropriate


Antimicrobial stewardship does not mean avoiding antibiotics when they are clinically indicated. Antibiotics remain essential for appropriate bacterial infections and for patients who are systemically unwell or at increased risk of complications. When an antibiotic is prescribed or supplied, pharmacists should consider:


• The indication, dose and duration • Allergy status and previous reactions


• Potential drug interactions and contraindications


• Renal function where relevant • Previous antibiotic exposure • Patient understanding of how to take the medicine


Current Northern Ireland guidance should always be consulted, as recommendations may change.


Safety-netting and referral Patients who are managed without antibiotics should understand when further medical assessment is required.


Red flags may include: • Rapid or significant deterioration • Severe breathlessness • Chest pain • Haemoptysis • Confusion or drowsiness • Severe systemic illness • Failure to improve within the expected timeframe


Patients who are frail, immunocompromised or have significant underlying respiratory, cardiac or other chronic conditions may require a lower threshold for referral.


The wider antimicrobial stewardship role


Every respiratory infection consultation provides an opportunity to improve understanding of antibiotics and AMR. Pharmacy teams can reinforce the message that antibiotics do not treat viral infections and that unnecessary use can contribute to resistance.


By combining clinical assessment, effective communication, appropriate symptomatic management and robust safety-netting, community pharmacists can help patients manage winter respiratory infections safely while protecting antibiotics for those who genuinely need them.


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