Antibiotics not needed for most respiratory infections

The Philadelphia-based American College of Physicians-American Society of Internal Medicine has released new guidelines that state that antibiotics are not needed for most respiratory tract infections. According to these guidelines, for most healthy adults, the best treatments for bronchitis, sinusitis, sore throat and non-specific upper respiratory tract infections are over-the-counter cold remedies and saltwater gargles to relieve symptoms.

The guidelines, four background papers on upper respiratory tract infections and an introductory essay were published in the Annals of Internal Medicine (vol. 134, no. 6).

"ACP-ASIM is concerned about the growing threat of antibiotic-resistant diseases," said Sandra Adamson Fryhofer, the society's president. "Up to 75% of antibiotics prescribed each year are associated with treating upper respiratory tract infections. Unfortunately, most of these prescriptions are unnecessary. As a professional organization representing internists who treat the majority of adult patients, we decided that our best contribution to reducing overuse and inappropriate use of antibiotics is to develop guidelines for the management of these common infections."

Patient concerns

The ACP-ASIM has also developed a patient education brochure that it hopes will encourage patients to discuss the dangers of antibiotic resistance with their doctors.

"Patients should not think they are getting poor treatment if their doctors don't prescribe antibiotics," said Vincenza Snow, senior medical associate at the ACP-ASIM. "Most colds and other respiratory tract infections are caused by viruses, and antibiotics don't affect viruses. Try nasal sprays, decongestants, cough drops and gargles to relieve symptoms before you call the doctor." Snow noted that the ACP-ASIM does not endorse any specific over-the-counter products or pharmaceuticals. "Finally, don't expect the symptoms to clear up right away," Snow said. "Colds usually last for up to two weeks."

The guidelines are designed for healthy adults. They are not intended for people over age 65 or those with other long-term medical conditions such as diabetes, heart or lung problems, Snow added.

Reliable evidence

The college's new guidelines are based on four background papers of principles for appropriate antibiotic use in upper respiratory tract infections developed by a Centers for Disease Control panel with representatives from the ACP-ASIM, the American Academy of Family Physicians and the Infectious Diseases Society of America. "The CDC is delighted to work with ACP-ASIM, AAFP and IDSA on efforts to reduce overuse of antibiotics," said Richard E. Besser, director of the CDC campaign to promote appropriate antibiotic use for respiratory infections. "A key element in the CDC's strategy to reduce overuse of antibiotics is to have reliable, evidence-based practice principles for physicians. The guidelines for upper respiratory tract infections provide these." PR