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[null,"Baseline assessment tool for guideline cough (acute): (NICE antimicrobial prescribing guideline NG120)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Cough (acute): antimicrobial prescribing.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with Cough (acute): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG120)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2019. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for Cough (acute): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG120)"]
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[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D38,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F38,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
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[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1  Managing acute cough "]
[null,"Be aware that an acute cough:\n• is usually self-limiting and gets better within 3 to 4 weeks without antibiotics\n• is most commonly caused by a viral upper respiratory tract infection, such as a cold or flu\n• can also be caused by acute bronchitis, a lower respiratory tract infection, which is usually a viral infection but can be bacterial\n• can also have other infective or non-infective causes.","1.1.1"]
[null,"For children under 5 with an acute cough and fever, follow the NICE guideline on fever in under 5s.","1.1.2"]
[null,"For adults with an acute cough and suspected pneumonia, follow the NICE guideline on pneumonia in adults: diagnosis and management.","1.1.3"]
[null,"Referral and seeking specialist advice"]
[null,"Refer people with an acute cough to hospital, or seek specialist advice on further investigation and management, if they have any symptoms or signs suggesting a more serious illness or condition (for example sepsis, a pulmonary embolism or lung cancer).","1.1.4"]
[null,"Treatment"]
[null,"Give general advice to people about:\n• the usual course of acute cough (lasts up to 3 or 4 weeks)\n• how to manage their symptoms with self-care (see the recommendations on self-care)\n• when to seek medical help, for example if symptoms worsen rapidly or significantly, do not improve after 3 to 4 weeks, or the person becomes systemically very unwell.","1.1.5"]
[null,"Do not offer the following treatments to people for an acute cough associated with an upper respiratory tract infection or acute bronchitis unless the person has an underlying airways disease, such as asthma:\n• an oral or inhaled bronchodilator (for example, salbutamol) or\n• an oral or inhaled corticosteroid.","1.1.6"]
[null,"Do not offer a mucolytic (for example acetylcysteine or carbocisteine) to treat an acute cough associated with an upper respiratory tract infection or acute bronchitis.","1.1.7"]
[null,"Acute cough associated with an upper respiratory tract infection"]
[null,"Do not offer an antibiotic to treat an acute cough associated with an upper respiratory tract infection in people who are not systemically very unwell or at higher risk of complications (see recommendation 1.1.15). Give advice about why an antibiotic is not needed.","1.1.8"]
[null,"Acute cough associated with acute bronchitis"]
[null,"Do not routinely offer an antibiotic to treat an acute cough associated with acute bronchitis in people who are not systemically very unwell or at higher risk of complications (see recommendation 1.1.15). ","1.1.9"]
[null,"Be aware that:\n• antibiotics do not improve the overall clinical condition of people with acute bronchitis\n• antibiotics make little difference to how long symptoms of acute bronchitis last (on average they shorten cough duration by about half a day)\n• antibiotics have possible adverse effects, particularly diarrhoea and nausea. ","1.1.10"]
[null,"For adults with an acute cough associated with acute bronchitis who have had a point of care C-reactive protein test after a clinical diagnosis of pneumonia has been ruled out, follow the NICE guideline on pneumonia in adults: diagnosis and management for recommendations on prescribing antibiotics according to C‑reactive protein results.","1.1.11"]
[null,"When no antibiotic prescription is given, give advice about why an antibiotic is not needed.","1.1.12"]
[null,"If an antibiotic prescription is given, give advice about possible adverse effects of the antibiotic, particularly diarrhoea and nausea.","1.1.13"]
[null,"Acute cough in people who are systemically very unwell or at higher risk of complications"]
[null,"For people with an acute cough who are identified at a face-to-face clinical examination as systemically very unwell, offer an immediate antibiotic prescription (see recommendation 1.3.1 for choice of antibiotic).","1.1.14"]
[null,"Be aware that people with an acute cough may be at higher risk of complications if they:\n• have a pre-existing comorbidity, such as significant heart, lung, renal, liver or neuromuscular disease, immunosuppression or cystic fibrosis\n• are young children who were born prematurely\n• are older than 65 years with 2 or more of the following criteria, or older than 80 years with 1 or more of the following criteria:\n- hospitalisation in previous year\n- type 1 or type 2 diabetes\n- history of congestive heart failure\n- current use of oral corticosteroids.","1.1.15"]
[null,"For people with an acute cough who are identified at a face-to-face clinical examination as at higher risk of complications, consider:\n• an immediate antibiotic prescription (see recommendation 1.3.1 for choice of antibiotic) or\n• a back-up antibiotic prescription. ","1.1.16"]
[null,"When an immediate antibiotic prescription is given, give advice about possible adverse effects of the antibiotic, particularly diarrhoea and nausea.","1.1.17"]
[null,"When a back-up antibiotic prescription is given, give advice about:\n• an antibiotic not being needed immediately\n• using the back-up prescription if symptoms worsen rapidly or significantly at any time.","1.1.18"]
[null,"Reassessment"]
[null,"Reassess people with an acute cough if their symptoms worsen rapidly or significantly, taking account of:\n• alternative diagnoses, such as pneumonia\n• any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis\n• previous antibiotic use, which may have led to resistant bacteria.","1.1.19"]
[null,"1.2  Self-care"]
[null,"Be aware that some people may wish to try the following self-care treatments, which have limited evidence of some benefit for the relief of cough symptoms:\n• honey (in people aged over 1)\n• pelargonium (a herbal medicine; in people aged 12 and over) \n• over-the-counter cough medicines containing the expectorant guaifenesin (in people aged 12 and over)\n• over-the-counter cough medicines containing cough suppressants, except codeine, (in people aged 12 and over who do not have a persistent cough, such as in asthma, or excessive secretions).","1.2.1"]
[null,"Be aware that limited evidence suggests that antihistamines, decongestants and codeine-containing cough medicines do not help cough symptoms. ","1.2.2"]
[null,"1.3  Choice of antibiotic"]
[null,"When prescribing antibiotics for an acute cough follow:\n• table 1 for adults aged 18 years and over\n• table 2 for children and young people under 18 years.","1.3.1"]

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[null,"Table 1. Antibiotics for adults aged 18 years and over"]
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[null,"Antibiotic1","Dosage and course length2"]
[null,"First choice"]
[null,"Doxycycline3","200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)"]
[null,"Alternative first choices4"]
[null,"Amoxicillin","500 mg three times a day for 5 days"]
[null,"Clarithromycin","250 mg to 500 mg twice a day for 5 days"]
[null,"Erythromycin","250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days"]
[null,"1See BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breast-feeding."]
[null,"2Doses given are by mouth using immediate-release medicines, unless otherwise stated."]
[null,"3Doxycycline should not be given to pregnant women, and the possibility of pregnancy should be considered in women of childbearing age (BNF, December 2018)."]
[null,"4Amoxicillin or erythromycin are preferred in women who are pregnant."]
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[null,"Table 2 Antibiotics for children and young people under 18 years"]
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[null,"Antibiotic1","Dosage and course length2"]
[null,"First choice"]
[null,"Amoxicillin","1 to 11 months, 125 mg three times a day for 5 days"]
[null,null,"1 to 4 years, 250 mg three times a day for 5 days"]
[null,null,"5 to 17 years, 500 mg three times a day for 5 days"]
[null,"Alternative first choices3"]
[null,"Clarithromycin","1 month to 11 years:"]
[null,null,"Under 8 kg, 7.5 mg/kg twice a day for 5 days"]
[null,null,"8 to 11 kg, 62.5 mg twice a day for 5 days"]
[null,null,"12 to 19 kg, 125 mg twice a day for 5 days"]
[null,null,"20 to 29 kg, 187.5 mg twice a day for 5 days"]
[null,null,"30 to 40 kg, 250 mg twice a day for 5 days"]
[null,null,"12 to 17 years, 250 mg to 500 mg twice a day for 5 days"]
[null,"Erythromycin","1 month to 1 year, 125 mg four times a day or 250 mg twice a day for 5 days"]
[null,null,"2 to 7 years, 250 mg four times a day or 500 mg twice a day for 5 days"]
[null,null,"8 to 17 years, 250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days"]
[null,"Doxycycline4","12 to 17 years, 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)"]
[null,"1See BNF for children for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment."]
[null,"2The age bands apply to children of average size and, in practice, the prescriber will use the age bands in conjunction with other factors such as the severity of the condition and the child’s size in relation to the average size of children of the same age. Doses given are by mouth using immediate‑release medicines, unless otherwise stated."]
[null,"3Amoxicillin or erythromycin are preferred in young women who are pregnant."]
[null,"4Doxycycline should not be given to young women who are pregnant and the possibility of pregnancy should be considered in young women of childbearing age (BNF for children, December 2018)."]