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Updated: Jul 16, 2026
Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases
Published on: March 1, 2024
Minimal use of antibiotics for acute respiratory tract infections: validity and patient satisfaction
Keisuke Tomii1, Yoshihisa Matsumura, Kenji Maeda
1Department of Pulmonary Medicine, Kobe City General Hospital. ktomii@kcgh.gr.jp
Background:
Antibiotics have been overused for acute respiratory tract infections (ARTIs) and the recent guidelines have emphasized limiting their use.
Objective:
To clarify the exact rate of antibiotic use and patient outcomes and satisfaction, under strict adherence to the guideline proposed by the American College of Physicians.
Design:
Prospective cohort observational study.
Setting:
Primary care clinics in Japan.
Patients:
783 patients diagnosed with ARTIs from October 2004 to April 2005, aged 15-64 and without any underlying disease.
Measurements:
Scores of symptoms and patient satisfaction at the 5th, 8th and 15th day of their initial visit, when treatment had been initiated according to that strategy.
Results:
In 691 non-influenza patients, comprising 554 (80%) cases of nonspecific upper respiratory tract infection (A), 11 (2%) of acute rhinosinusitis (B), 90 (13%) of acute pharyngitis (C) and 36 (5%) of acute bronchitis (D); the rates of antibiotic use were 5% [0.2%; (A), 9%; (B), 36%; (C), 3%; (D)] initially and 2% [2%; (A), 0%; (B), 1%; (C), 3%; (D)] subsequently. For the remaining 92 influenza patients, no antibiotics were prescribed, though oseltamivir was prescribed in 89 (97%). Within 7 days, more than 90% of all patients felt improved and expressed their satisfaction with the treatment. Furthermore, no patients needed emergency room visits or hospital admission.
Limitations:
Only patients who gave informed consent were enrolled.
Conclusions:
Adhering to the guideline, antibiotic use could be limited to only 5-7% of non-influenza ARTIs-mainly acute pharyngitis-without any problems and with a high degree of patient satisfaction.
Insights
Limiting antibiotic use for acute respiratory tract infections (ARTIs) to 5-7% in non-influenza cases, primarily acute pharyngitis, is achievable without compromising patient outcomes or satisfaction. This adherence to guidelines ensures appropriate antibiotic stewardship.
Area of Science:
- Infectious Diseases
- General Practice
- Public Health
Background:
- Overuse of antibiotics for acute respiratory tract infections (ARTIs) is a significant concern.
- Recent guidelines advocate for limiting antibiotic prescriptions in ARTIs.
Purpose of the Study:
- To evaluate antibiotic prescribing rates and patient outcomes under strict adherence to American College of Physicians guidelines.
- To assess patient satisfaction with limited antibiotic use for ARTIs.
Main Methods:
- Prospective cohort observational study conducted in Japanese primary care clinics.
- Included 783 patients aged 15-64 diagnosed with ARTIs.
- Monitored symptom scores and patient satisfaction on days 5, 8, and 15.
Main Results:
- Antibiotic use was 5% initially and 2% subsequently in non-influenza ARTIs.
- Acute pharyngitis accounted for the majority of antibiotic prescriptions (36%).
- Over 90% of patients reported improvement and high satisfaction within 7 days, with no emergency visits or hospital admissions.
Conclusions:
- Strict adherence to guidelines can significantly limit antibiotic use in non-influenza ARTIs (5-7%).
- Acute pharyngitis remains the primary indication for antibiotics in this context.
- Limited antibiotic prescribing is associated with positive patient outcomes and high satisfaction.
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