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Why is this guideline needed?

Before the COVID-19 pandemic, people with Acute Respiratory Infections (ARI’s) presented via NHS 111 service or came into primary care for assessment. More serious cases self-presented to A&E, sometimes arriving by ambulance.  Post-COVID, the number of ARI’s and people presenting with symptoms has increased, putting pressure across healthcare settings. ARI Hubs and Virtual Wards have been established to manage the increased number of ARI’s since the pandemic, to try and relieve pressure from other areas of the healthcare system.

What does the guideline cover?

The intention is that this guideline will aid healthcare professionals in deciding where to refer people aged 16 and over with suspected acute respiratory infections including referrals to Virtual Wards and ARI Hubs.

  • All first contact with NHS services
  • Remote contact with NHS Services at first presentation.
  • In-person contact with NHS Services at first presentation.

What isn’t covered? The new guideline NG237 does not cover:

  • People with known COVID-19
  • People under the age of 16.
  • The ongoing management of ARI after first assessment.
  • Management of exacerbations of underlying respiratory conditions.
  • Management of Tuberculosis.

What does it mean?

From a diagnostic testing perspective, there are several points within this new guideline that are pertinent. In section 1.3 on page 8 of the guideline:

  • Rapid POC Microbiology tests

1.3.3. Do not offer rapid POC microbiological tests or influenza tests to people with suspected ARI to determine whether to prescribe antimicrobials. Testing may be indicated for surveillance or infection.

The evidence showed that POC Microbiological tests for people with suspected ARI’s were not accurate to determine whether an infection was bacterial or viral (page 17).

  • Point of care Flu Testing

As above in section 1.3.3 and states:

1.3.5. Follow seasonal advice from the UK Health Security Agency (UKHSA) on managing influenza-like illness.

Page 17 – The evidence for flu testing showed that some tests were reliable at identifying people with and without flu; however, the committee did not recommend them because the decision to prescribe antivirals for flu-like illness was based mainly on seasonal advice from the UK Health Security Agency (UKHSA). They noted that flu tests could be useful for surveillance and for infection control, but that was outside the remit of this guideline.

  • CRP Point of Care Testing

1.3.4. If, after clinical assessment, it is unclear if antibiotics are needed for someone with a lower respiratory tract infection, consider a point-of-care C-reactive protein (CRP) test to support clinical decision making.

The NICE committee agreed that the current evidence based for C-Reactive Protein testing is limited (page 17).

In terms of the “Recommendations for research” section on page 12 of the guideline, there is funding available from the National Institute for Health and Care Research (NIHR) for projects that address NICE Research Recommendations.