ACP/CDC Provide Guidelines on the Use of Antibiotics for Acute Respiratory Tract Infection
Am Fam Physician. 2016 Dec 15;94(12):1016.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Antibiotics are not indicated for acute uncomplicated bronchitis unless pneumonia is present.
• Group A streptococcal pharyngitis should be ruled out, and antibiotics used only if streptococcal pharyngitis is confirmed.
• Antibiotics are indicated in acute rhinosinusitis only for patients demonstrating symptoms of bacterial etiology.
• Antibiotics are not indicated for the common cold.
From the AFP Editors
Approximately one-half of outpatient antibiotic prescriptions may be inappropriate or unnecessary, imposing high economic and public health costs. The American College of Physicians (ACP) and Centers for Disease Control and Prevention (CDC) guideline on appropriate antibiotic use in the treatment of healthy adults with acute respiratory tract infection outlines one of the medical community's top priorities. Currently, most antibiotics prescribed in the office setting are for illnesses in this category, despite evidence that they may cause harm or otherwise do not benefit patients with some of the most common infections.
Providing High-Value Care
Nonviral etiologies of acute uncomplicated bronchitis are rare but often indistinguishable from viral causes. Bacterial infections may not always warrant antibiotics, such as in cases of acute cough. Evidence does not show a higher standard of clinical improvement when antibiotics are used to treat bronchitis compared with placebo. Over-the-counter therapies, which are less likely to cause harm, may provide symptom relief. Diagnostic testing and antibiotic therapy for acute uncomplicated bronchitis should be avoided unless pneumonia is suspected.
Pharyngitis is similarly unlikely to be caused by a bacterial pathogen, but requires that physicians use rapid antigen detection testing, throat culture, or both to rule out group A Streptococcus or serious infection if suspicious symptoms are present. Clinical scoring systems are available to assist in differentiating bacterial from viral etiologies of
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2016 by the American Academy of Family Physicians.
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