ACP, CDC advise on antibiotic use for respiratory conditions

In the latest move to counter the antibiotic resistance threat, the American College of Physicians (ACP) and the US Centers for Disease Control and Prevention (CDC) yesterday released guidance for physicians on prescribing the drugs for common acute respiratory conditions in adults, such as colds, bronchitis, sore throat, and sinus infection.

The new guidance, published in the Annals of Internal Medicine, said doctors prescribe antibiotics at more than 100 million adult clinic visits each year, 41% written for acute respiratory tract infections (ARTIs), making the practice a key contributor to the antibiotic resistance threat.

The CDC estimates that inappropriate antibiotic prescribing in outpatient settings costs $3 billion in excess costs each year.

Updates 2001 guidance

In penning the advice, ACP and CDC researchers dug into the medical literature on antibiotic prescribing for the different ARTIs. They said the goal of the new document is to augment rather than replace existing recommendations and to update  2001 guidance on appropriate antibiotic use for adult respiratory infections and to complement similar advice issued for children in 2013.

In an ACP press release, ACP President Wayne Riley, MD, MPH, said, "Reducing 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."

One of the themes is that antibiotics do little or nothing to help the conditions and can have side effects, and that telling patients what to expect and initiating symptom treatment is the best plan.

Tailored recommendations

The authors tailored their recommendations for each of the four ARTIs.

For common colds, doctors shouldn't prescribe antibiotics, they write, but instead should let patients know that symptoms can linger for up to 2 weeks and that they should follow up if symptoms worsen or last longer than expected. Patients should be counseled and the benefits and drawbacks of symptomatic therapy and that unneeded antibiotics can have side effects.

Uncomplicated bronchitis shouldn't trigger testing or antibiotics, unless the doctor suspects pneumonia. Symptom relief can consist of cough suppressants, expectorants, antihistamines, decongestants, and beta agonists.

For sore throats, symptomatic treatment such as analgesics for pain is the treatment mainstay, according to the authors, who also recommend reassuring patients that the discomfort typically lasts less than a week. Patients who have symptoms of group A streptococcal pharyngitis (ie, persistent fevers or other symptom combination) should undergo the rapid strep test or culture for group A Streptococcus, with antibiotics reserved only for patients with confirmed infections.

Patients with uncomplicated sinus infections should know that the condition usually resolves without antibiotics, even when the cause is bacterial, according to the report. It added that most patients can be managed with supportive care, including analgesics for pain and antipyretics for fever.

Antibiotics should be reserved for patients who have symptoms lasting longer than 10 days, with the onset of severe symptoms and high fever, nasal discharge or facial pain lasting longer than 3 consecutive days, or when symptoms worsen after a typical viral illness lasting 5 days seemed to be resolving.

Other evidence-based strategies physicians can use include labeling bronchitis as a "chest cold" or "viral upper respiratory infection" and giving patients information sheets to take home about inappropriate antibiotic use and alternatives for relieving symptoms during ARTIs. Another tactic is a symptom "prescription pad" that can provide recommendations and raise the possibility of antibiotic treatment if a patient's symptoms don't improve.

See also:

Jan 19 Ann Intern Med report

Jan 19 ACP press release

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