Guideline for the management of upper respiratory tract infections.
BACKGROUND
Inappropriate use of antibiotics for upper respiratory tract infections (URTIs), many of which are viral, adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS).


METHODS
The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline is a consensus document based upon the opinions of the working group.


RESULTS
Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/ kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children < or = 2 years of age, in day-care attendees, in cases with prior AOM within the past 6 months, and in children who have received antibiotics within the last 3 months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones.


CONCLUSIONS
The guideline should assist rational antibiotic prescribing for URTIs. However, it should be updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.
Brink
A J
AJ
Du Buisson, Bruinette and Partners, Ampath, Johannesburg.
Cotton
M F
MF
Feldman
C
C
Geffen
L
L
Hendson
W
W
Hockman
M H
MH
Maartens
G
G
Madhi
S A
SA
Mutua-Mpungu
M
M
Swingler
G H
GH
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D029481:Bronchitis, Chronic / Q000188:drug therapy / Q000382:microbiology; D003139:Common Cold / Q000188:drug therapy; D024881:Drug Resistance, Bacterial; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D012307:Risk Factors; D012852:Sinusitis / Q000188:drug therapy / Q000382:microbiology; D013019:South Africa; D013296:Streptococcus pneumoniae / Q000187:drug effects; D014069:Tonsillitis / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents