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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

1. Gonzales R, Bartlett JG, et al. 2001 Annals of Internal Medicine 134: 479-486.
2. Snow V, Mottur-Pilson C, Gonzales R. 2001 Annals of Internal Medicine 134: 487-89.
3. Gonzales R, Bartlett JG, Besser R, et al. 2001 Annals of Internal Medicine 134: 490-494.
4. Snow V, Mottur-Pilson C, Hickner JM. 2001 Annals of Internal Medicine 134: 495-497.
5. Hickner JM, Bartlett J, Besser R, et al. 2001 Annals of Internal Medicine 134: 498-505.
6. Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR. 2001 Annals of Internal Medicine 134: 506-508.
7. Cooper RJ, Hoffman JR , Bartlett J, et al. 2001 Annals of Internal Medicine 134: 509-517.
8. Snow V, Mottur-Pilson C, Gonzales R. 2001 Annals of Internal Medicine 134: 518-520.
9. Gonzales R, Bartlett JG, Besser R, et al. 2001 Annals of Internal Medicine 134: 521-529.