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GuidelinesfortheUseofAntibioticsinAcuteUpperRespiratory
TractInfections

TABLE2
ClinicalPracticeGuidelinesCompendium:AdultswithURI

INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

Acutebacterial Whentotreat Antibiotic Firstlinetherapy

sinusitisStreptococcus withan duration:10 Amoxicillin
pneumoniae, antibiotic: days
nontypeable diagnosismaybe Alternativetherapy
Failureto Amoxicillin/clavulanate
Haemophilusinfluenzae, madeinadults
respondafter (Augmentin),
Moraxellacatarrhalis, withsymptomsof
72hoursof cefpodoxime(Vantin),
mainlyviralpathogens aviralupper
antibiotics: cefdinir(Omnicef),
respiratory
reevaluate respiratoryquinolones
infectionthathave
patientand (gatifloxacin[Tequin],
notimprovedafter
switchto levofloxacin
10daysorthat
alternate [Levaquin],
worsenafterfive
antibiotics moxifloxacin[Avelox])
tosevendays.
Diagnosismay Forbetalactam
includesomeor allergy:TMPSMX
allofthefollowing: (Bactrim,Septra),
nasaldrainage, doxycycline
nasalcongestion, (Vibramycin),
facialpressureor azithromycin
pain(especially (Zithromax),
whenunilateral clarithromycin(Biaxin)
andfocusedinthe
regionofa
particularsinus),
postnasal
discharge,
hyposmia,
anosmia,fever,
cough,fatigue,
maxillarydental
pain,earpressure
orfullness.

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INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

Whennotto
treatwithan
antibiotic:nearly
allcasesresolve
withoutantibiotics.
Antibioticuse
shouldbe
reservedfor
moderate
symptomsthatare
notimproving
after10daysor
thatworsenafter
fivetosevendays,
andsevere
symptoms.

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INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

Pharyngitis Whentotreat GroupA Firstlinetherapy

Streptococcuspyogenes, withan streptococcal PenicillinV(Veetids),
routinerespiratory antibiotic:S. infection, penicillinG
viruses pyogenes(group antibiotic benzathine(Bicillin
Astreptococcus duration:10 LA)
infection). days
Symptomsofsore Alternativetherapy
throat,fever, Amoxicillin,
headache. macrolides
Physicalfindings (erythromycin
includefever, preferredinpatients
tonsillopharyngeal allergictopenicillin),
erythemaand oralcephalosporins,
exudates,palatal clindamycin(Cleocin)
petechiae,tender
andenlarged
anteriorcervical
lymphnodes,and
absenceofcough.
Confirmdiagnosis
withthroatculture
orrapidantigen
testingbefore
usingantibiotics
negativerapid
antigentest
resultsmaybe
confirmedwith
throatculture.

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INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

Whennotto
treatwithan
antibiotic:most
pharyngitiscases
areviralinorigin.
Thepresenceof
thefollowingis
uncommonwith
groupA
streptococcal
infectionand
pointsawayfrom
usingantibiotics:
conjunctivitis,
cough,rhinorrhea,
diarrhea,and
absenceoffever.

Nonspecificcough Whentotreat Uncomplicated: Chronicbronchitisand

illness/acutebronchitis withan notindicated COPD:amoxicillin,
Bordetellapertussis, antibiotic: TMPSMX,or
Chlamydia antibioticsnot doxycycline
pneumoniae/Mycoplasma indicatedin
Other(B.pertussis,C.
pneumoniae patientswith
pneumoniae,M.
uncomplicated
pneumoniae):
acutebacterial
erythromycinor
bronchitis.Sputum
doxycycline
characteristicsnot
helpfulin
determiningneed
forantibiotics.
Treatmentis
reservedfor
patientswithacute
bacterial
exacerbationof
chronicbronchitis
andCOPD,
usuallysmokers.
Inpatientswith
severesymptoms,
ruleoutother
moreserious
conditions(e.g.,
pneumonia).

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INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

Whennotto
treatwithan
antibiotic:90
percentofcases
arenonbacterial.
Literaturefailsto
supportuseof
antibioticsin
adultswithout
historyofchronic
bronchitisorother
comorbid
condition.

Nonspecificupper Whennotto Notindicated None

respiratoryinfection treatwithan
Viral antibiotic:
Antibioticsnot
indicated
however,
nonspecificupper
respiratory
infectionisa
majoretiologic
causeofacute
respiratory
illnesses
presentingto
primarycare
physicians.
Patientsoften
expecttreatment.
Attemptto
discourage
antibioticuseand
explain
appropriate
treatment.

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INDICATIONS
ILLNESS/PATHOGEN FORANTIBIOTIC TREATMENT ANTIBIOTIC
TREATMENT

InfluenzaInfluenzavirus Whennotto Antibioticsnot Antiviralmedications

treatwithan indicated,but availableforacute
antibiotic: patientsoften reliefofsymptoms
antibioticsnot expect andforpreventionin
indicated.For treatment. somecases
acutetreatment,
supportiveand
symptomaticcare
isthestandard.
Characterizedby
abruptonsetof
constitutionaland
respiratorysigns
andsymptoms
suchasfever,
myalgia,
headache,rhinitis,
severemalaise,
nonproductive
cough,andsore
throat..

Theincubation
periodfor
influenzaisoneto
fourdays,withan
averageoftwo
days.Adults
typicallyare
infectiousfromthe
daybefore
symptomsbegin
through
approximatelyfive
daysafteronsetof
illness

NOTE :Thisguidelinesummaryisintendedforphysiciansandhealthcareprofessionalstoconsiderinmanaging
thecareoftheirpatientsforacuterespiratorytractinfections.Althoughthesummarydescribesrecommended
coursesofintervention,itisnotintendedasasubstitutefortheadviceofaphysicianorotherknowledgeable
healthcareprofessionals.Theseguidelinesrepresentbestclinicalpracticeatthetimeofpublication,but
practicestandardsmaychangeasmoreknowledgeisgained.

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URI=upperrespiratoryinfectionTMPSMX=trimethoprim/sulfamethoxazoleCOPD=chronicobstructive
pulmonarydisease.

AdaptedwithpermissionfromCaliforniaMedicalAssociationFoundation.AllianceWorkingforAntibiotic
ResistanceEducation(AWARE)clinicalpracticeguidelines.AccessedAugust3,2006,
at:http://www.aware.md/clinical/clinical_guide.asp.

Copyright2006bytheAmericanAcademyofFamilyPhysicians.
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