Guidelines for the use of antibiotics in acute upper respiratory tract infections
David M Wong1, Dean A Blumberg, Lisa G Lowe
1Arrowhead Regional Medical Center Family Medicine Residency Program, Colton, California 92324, USA.
Insights
Physicians should judiciously prescribe antibiotics for upper respiratory tract infections. Guidelines recommend observation for some children with acute otitis media and specific criteria for treating bacterial rhinosinusitis and streptococcal pharyngitis.
Area of Science:
- Infectious Diseases
- Pediatrics
- General Practice
Background:
- Antibiotic resistance is a growing concern, necessitating appropriate prescribing practices.
- Physicians require clear guidance on antibiotic use for common upper respiratory tract infections (URTIs) in both children and adults.
- Existing guidelines for URTIs often lack synthesis, leading to potential overuse or underuse of antibiotics.
Purpose of the Study:
- To provide physicians with summarized, key practice points for the appropriate use of antibiotics in common URTIs.
- To evaluate existing guidelines and synthesize recommendations for diagnosing and treating acute otitis media, acute bacterial rhinosinusitis, streptococcal pharyngitis, and acute bronchitis.
Main Methods:
- A multidisciplinary team reviewed and evaluated existing clinical guidelines for URTIs.
- Key practice points were extracted and summarized for practical application by physicians.
- Focus was placed on diagnostic criteria and treatment recommendations, including antibiotic stewardship principles.
Main Results:
- Acute otitis media in children requires specific diagnostic criteria (abrupt onset, effusion, inflammation); observation without immediate antibiotics is an option.
- Acute bacterial rhinosinusitis treatment is indicated only after 10 days of un-improved symptoms or worsening after 5-7 days.
- Group A streptococcal pharyngitis generally requires testing, though empiric therapy is permissible with high clinical suspicion; acute bronchitis in healthy adults should not be treated with antibiotics.
Conclusions:
- Judicious antibiotic use in URTIs is crucial for combating resistance and improving patient outcomes.
- Clear diagnostic criteria and adherence to evidence-based treatment guidelines can reduce inappropriate antibiotic prescriptions.
- Delayed prescriptions and patient education are valuable tools for managing patient expectations and promoting antibiotic stewardship.
Abstract:
To help physicians with the appropriate use of antibiotics in children and adults with upper respiratory tract infection, a multidisciplinary team evaluated existing guidelines and summarized key practice points. Acute otitis media in children should be diagnosed only if there is abrupt onset, signs of middle ear effusion, and symptoms of inflammation. A period of observation without immediate use of antibiotics is an option for certain children. In patients with sinus infection, acute bacterial rhinosinusitis should be diagnosed and treated with antibiotics only if symptoms have not improved after 10 days or have worsened after five to seven days. In patients with sore throat, a diagnosis of group A beta-hemolytic streptococcus pharyngitis generally requires confirmation with rapid antigen testing, although other guidelines allow for empiric therapy if a validated clinical rule suggests a high likelihood of infection. Acute bronchitis in otherwise healthy adults should not be treated with antibiotics; delayed prescriptions may help ease patient fears and simultaneously reduce inappropriate use of antibiotics.
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