National Institute for Health and Clinical Excellence (NICE)
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Saving antibiotics – supporting decisions

Blog posted by: Dr Jacob F. de Wolff, consultant acute physician and honorary senior lecturer, 29 August 2017.

Jacob tells us how NICE guidance has helped him to decide when to give antibiotics and why this is important.

Diagnosing an infection isn’t always easy and finding its cause can take time we do not have.

We are often faced with a difficult decision about whether to be cautious and use broad-spectrum antibiotics, or whether to hold off and run more tests.

In the last few decades we have learnt a lot about the harms of using of antibiotics when they are not needed.

Overuse of these medicines has allowed bacteria to become resistant to them, which means we frequently face infections that do not respond to treatment.

And many patients experience side-effects ranging from annoying rashes to severe allergies and life-threatening forms of hepatitis.

As a trainee I saw someone die as a result of antibiotic-acquired Clostridium difficile-associated diarrhoea. This happened because the antibiotics interfered with healthy bacteria usually found in the gut. Seeing it happen left an indelible impression on me.

When NICE published its guidance for treating pneumonia in adults my eye was drawn to their antibiotic advice.

NICE recommended a specific blood test as a way to determine whether someone needed antibiotics. The test assesses levels of C-reactive protein (CRP). This is something our body produces when it is battling with inflammation, which is a common during infection.

NICE says that people with a low CRP (<20 mg/l) and no signs of pneumonia are unlikely to need antibiotics. But that those with an intermediate result (20-100 mg/l) should be given antibiotics if their symptoms worsen.

I do have to make exceptions to this, for example when someone has a weakened immune system they’ll need to be treated cautiously. But this advice from NICE has undoubtedly prevented myself and others from giving antibiotics needlessly, which is a good thing.

I am hopeful that the new guidelines being produced by NICE will give doctors more support in their decision-making around antibiotics, including when not to prescribe them. We have a duty to save antibiotics for those who need them most.


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