[Antimicrobial use in acute upper respiratory infections in family medicine]

Area of Science:

• Family Medicine
• Infectious Diseases
• Pharmacology

Context:

• Acute upper respiratory infections (URIs) are a leading reason for primary care visits globally.
• Significant antibiotic overuse occurs in managing URIs, contributing to resistance.
• Many URI cases resolve spontaneously without antimicrobial intervention.

Purpose:

• To evaluate the judicious use of antimicrobial drugs in treating acute upper respiratory infections.
• To differentiate conditions that require antibiotics from those that do not.
• To provide guidance on appropriate antimicrobial prescribing for URIs.

Summary:

• The majority of acute rhinopharyngitis (common cold) and acute sinusitis cases resolve without antibiotics.
• Acute otitis media requires differentiation from otitis media with effusion; antibiotics are ineffective for the latter unless chronic (>3 months).
• Acute pharyngitis management should focus on odynophagia syndrome criteria, and acute bronchitis does not significantly benefit from antibiotics. Quinolones are unsuitable for URIs.

Impact:

• Reducing unnecessary antibiotic prescriptions by an estimated 50 million globally.
• Promoting antimicrobial stewardship to combat antibiotic resistance.
• Improving patient outcomes by guiding appropriate treatment strategies for URIs.