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APUA
& ACP: Acute upper respiratory tract infections
Excerpted
from:
V.
Snow. Guidelines for Antibiotic Use from the American College
of Physicians, APUA Newsletter,
2001, 19(2):1
Other practitioner
guidelines
Urinary
tract infections
Otitis media
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Summary
of Guidelines for the Appropriate Use of Antibiotics ACP-ASIM
2001
The ACP-ASIM
guidelines provide practical recommendations for clinicians on
how to differentiate viral from bacterial infections, and they
dispel the common misperception that purulent secretions indicate
bacterial infection. They describe under what circumstances patients
would benefit from antibiotic treatment or when symptomatic treatment
only is indicated. They guide clinicians in their choice of antibiotics,
favoring the narrow-spectrum agents. Finally, we hope that they
raise consciousness among clinicians as to the importance of restricting
the use of antibiotics, particularly broad-spectrum antibiotics,
in upper respiratory infections.
Upper
Respiratory Tract Infections (URIs)
- URI
is a nonspecific upper respiratory infection in which sinus,
pharyngeal and lower airway symptoms are frequently present
but are not prominent.
- These
infections are predominantly viral in origin and complications
are rare.
- Antibiotics
should not be used for nonspecific URI in previously healthy
adults.
- It is
appropriate to offer symptomatic treatments such as decongestants,
analgesics, and antipyretics.
Acute
Sinusitis
- Sinus
radiography is not recommended for the diagnosis of uncomplicated
sinusitis.
- Mild
or moderate acute bacterial sinusitis does not require antibiotic
treatment; appropriate doses of analgesics, decongestants, and
so on should be offered.
- Severe
or persistent moderate symptoms and specific findings of bacterial
sinusitis (such as unilateral facial pain, unilateral maxillary
pain, and facial swelling lasting longer than 7 days) can be
treated with antibiotics, in addition to appropriate symptomatic
treatment.
- Narrow-spectrum
antibiotics are reasonable first-line agents (amoxicillin, trimethoprim-sulfa,
and doxycycline).
Acute
Pharyngitis
- All
patients with pharyngitis should be offered appropriate doses
of analgesics, antipyretics and other supportive care.
- Only
about 10% of pharyngitis in adults is due to having Group A
beta-hemolytic streptococcus (GABHS). Antibiotics should be
limited to those with the highest probability of GABHS.
- The
preferred antimicrobial treatment of GABHS pharyngitis is penicillin
or erythromycin in penicillin-allergic patients.
Acute
Bronchitis
- Antibiotics
are not recommended for the treatment of uncomplicated acute
bronchitis in previously healthy adults, regardless of the duration
of cough.
- Production
of yellow or green phlegm is not an indication of bacterial
infection.
- Almost
all acute bronchitis is caused by viruses.
- Appropriate
doses of analgesics, cough suppressants, and other symptomatic
relief should be offered.
References
- Gonzales
R, Bartlett JG, et al. 2001 Annals of Internal Medicine 134:
479-486.
- Snow
V, Mottur-Pilson C, Gonzales R. 2001 Annals of Internal Medicine
134: 487-89.
- Gonzales
R, Bartlett JG, Besser R, et al. 2001 Annals of Internal Medicine
134: 490-494.
- Snow
V, Mottur-Pilson C, Hickner JM. 2001 Annals of Internal Medicine
134: 495-497.
- Hickner
JM, Bartlett J, Besser R, et al. 2001 Annals of Internal Medicine
134: 498-505.
- Snow
V, Mottur-Pilson C, Cooper RJ, Hoffman JR. 2001 Annals of Internal
Medicine 134: 506-508.
- Cooper
RJ, Hoffman JR , Bartlett J, et al. 2001 Annals of Internal
Medicine 134: 509-517.
- Snow
V, Mottur-Pilson C, Gonzales R. 2001 Annals of Internal Medicine
134: 518-520.
- Gonzales
R, Bartlett JG, Besser R, et al. 2001 Annals of Internal Medicine
134: 521-529.
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