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How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an
Otávio Bejzman Piltcher1, Eduardo Macoto Kosugi2, Eulalia Sakano3
1Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (FAMED), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil.
Introduction:
Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections.
Objectives:
To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality.
Methods:
A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists.
Results:
Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'.
Conclusions:
Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.
Insights
Antibiotic resistance is a growing concern, particularly with inappropriate use for upper respiratory infections. Judicious antibiotic prescribing is crucial for acute otitis media, rhinosinusitis, and pharyngotonsillitis to prevent complications and curb resistance.
Area of Science:
- Infectious Diseases
- Public Health
- Otolaryngology
Background:
- Rising bacterial resistance is a significant public health issue, driven by inappropriate antibiotic use.
- Antimicrobial resistance increases hospitalization duration, treatment costs, and mortality from infectious diseases.
- A substantial portion of outpatient antibiotic prescriptions are for acute upper respiratory infections (URIs), including rhinosinusitis, otitis media, and pharyngotonsillitis.
Purpose of the Study:
- To review current antibiotic guidelines for common URIs.
- To adapt international recommendations to national contexts.
- To guide rational antibiotic use in otorhinolaryngology.
Main Methods:
- Literature review of PubMed database for antibiotic management of URIs.
- Inclusion of medical management for acute otitis media, acute rhinosinusitis, and pharyngotonsillitis.
- Discussion and consensus building with a panel of specialists.
Main Results:
- Antibiotics should be prescribed judiciously for uncomplicated acute URIs.
- Clinical presentation severity and complication risk are key factors in prescribing decisions.
- Consideration of potential suppurative and non-suppurative complications is essential.
Conclusions:
- Regular guideline updates are necessary for rational antibiotic use in acute infections.
- Continuous medical education is vital for physicians and patients regarding antibiotic therapy.
- Shifting the paradigm away from universal antibiotic use for URIs is critical to mitigate resistance and adverse outcomes.
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