The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) has issued advice on appropriate antibiotic use for acute respiratory tract infections (ARTIs) in adults. The paper was published in the Annals of Internal Medicine.

ACP President Wayne J. Riley, MD, MPH, MBA, MACP, explained that reducing the overuse of antibiotics for ARTIs in adults is, “a clinical priority and a High Value Care way to improve quality of care, lower health care costs, and slow and/or prevent the continued rise in antibiotic resistance.” Unpublished data from the CDC show that about 50% of antibiotic prescriptions may be unnecessary or inappropriate in the outpatient setting.

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Study authors presented the best practices for antibiotic use in healthy adults (without chronic lung disease or immunocompromising conditions) presenting with ARTI. They conducted a narrative literature review of evidence on appropriate antibiotic use for ARTI in adults, and complemented professional guidelines with various meta-analyses, systematic reviews, and randomized clinical trials. 

The paper includes the following High-Value Care Advice:

  • Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
  • Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (eg, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
  • Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
  • Clinicians should not prescribe antibiotics for patients with the common cold.

The ACP and CDC urged clinicians to promote appropriate antibiotic use by labeling acute bronchitis as a “chest cold” or “viral upper respiratory tract infections,” and providing patients with information sheets on proper use and alternatives to antibiotics. Another strategy was to use a symptomatic prescription pad to recommend ways to manage patients’ symptoms. If it is unclear whether antibiotics are needed, clinicians can provide a delayed or post-dated antibiotic prescription as a future possibility if the condition does not improve. 

The study authors concluded that reducing inappropriate antibiotic prescribing will “improve quality of care, decrease health care costs, and preserve the effectiveness of antibiotics.” 

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