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[When and why are antibiotics indicated in airway infections (except pneumonia)?]
O Brändli1, T Luterbacher, N Egli
1Zürcher Höhenklinik Wald, Faltigberg.
Abstract:
Infections of the upper airways reduce life quality of adults on average twice, that of children even 4 to 8 times a year. Usually these are viral infections subsiding spontaneously without antibiotics. Only if concomittant circumstances arise and in specific clinical situations (otitis, sinusitis, tonsillitis, epiglottitis) as well as in acute exacerbation of chronic bronchitis are antibiotics already indicated at first consultation. The physician who is usually consulted by a patient with increasing discomfort under self-medication and who is expecting an antibiotic treatment has next to the clinical findings and prior laboratory test results to consider before all the individual (home, workplace, school) and epidemiologic (influenza) situation, the possible pathogens, their susceptibility to antibiotics as well as the side effects and costs for the decision to prescribe antibiotics. Today because of an increasing pressure of selection for pathogens resistant to antibiotics a greater reluctance to prescribe antibiotics is recommended. This requires close follow-up of the patient with symptomatic treatment or only short "probatory" antibiotic therapy and a good patient-physician relationship.
Insights
Upper airway infections significantly impact quality of life. Antibiotic prescriptions for these common viral illnesses should be approached with caution due to rising antibiotic resistance, prioritizing symptomatic care and close patient monitoring.
Area of Science:
- General Medicine
- Infectious Diseases
- Pharmacology
Context:
- Upper airway infections are common, affecting adults twice and children 4-8 times annually.
- Most upper airway infections are viral and resolve without antibiotics.
- Antibiotics are indicated for specific conditions like otitis, sinusitis, tonsillitis, epiglottitis, and acute exacerbations of chronic bronchitis.
Purpose:
- To guide physicians on judicious antibiotic prescribing for upper airway infections.
- To emphasize the importance of considering individual and epidemiological factors before prescribing antibiotics.
- To advocate for a more reluctant approach to antibiotic prescription due to antibiotic resistance.
Summary:
- Physicians must evaluate clinical findings, patient history, and individual/epidemiological factors (e.g., influenza) when deciding on antibiotic treatment.
- Consideration of potential pathogens, antibiotic susceptibility, side effects, and costs is crucial.
- A greater reluctance to prescribe antibiotics is recommended to combat increasing antibiotic resistance.
Impact:
- Promotes conservative antibiotic use, reducing the development of resistant pathogens.
- Encourages symptomatic treatment and short-term "probatory" antibiotic therapy when necessary.
- Highlights the importance of a strong patient-physician relationship for effective management and adherence to treatment plans.