Choosing Wisely:

Avoid prescribing antibiotics for upper respiratory infections.

Rationale and Comments: The majority of acute upper respiratory infections are viral in etiology, and the use of antibiotic treatment is ineffective, inappropriate, and potentially harmful. However, proven infection by Group A Streptococcal disease (Strep throat) and pertussis (whooping cough) should be treated with antibiotic therapy. Symptomatic treatment for upper respiratory infections should be directed to maximize relief of the most prominent symptom(s). It is important that health care providers have a dialogue with their patients and provide education about the consequences of misusing antibiotics in viral infections, which may lead to increased costs, antimicrobial resistance, and adverse effects.
Sponsoring Organizations:
  • Infectious Diseases Society of America
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Disciplines:
  • Infectious disease
  • References: • Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-112.
    • Zoorod R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012;86(9):817-22.
    • Adult appropriate antibiotic use summary: physician information sheet (adults) [Internet].Atlanta (GA): The Centers for Disease Control and Prevention; 2012 May 1 [updated 2012 Jun 25; cited 2015 Jan 28]. Available from:

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