title: Updated recommendations for the management of upper respiratory tract infections in South Africa.
abstract: BACKGROUND
  Inappropriate use of antibiotics for non-severe upper respiratory tract infections (URTIs), most of which are viral, significantly adds to the burden of antibiotic resistance. Since the introduction of pneumococcal conjugate vaccines in 2009 in South Africa, the relative frequency of the major bacterial pathogens causing acute otitis media (AOM) and acute bacterial rhinosinusitis (ABRS) has changed.
  
  
  CONCLUSIONS
  Since URTIs are mostly viral in aetiology and bacterial AOM and ABRS frequently resolve spontaneously, the guideline includes diagnostic criteria to separate viral from bacterial causes and hence, those patients not requiring antibiotics. Penicillin remains the drug of choice for tonsillopharyngitis. Amoxicillin remains the drug of choice for both AOM and ABRS. A dose of 90 mg/kg/day is recommended for children, which should be effective for pneumococci with high-level penicillin resistance and will also cover most infections with H. influenzae. Amoxicillin-clavulanate (in high-dose amoxicillin formulations available for both children and adults) should be considered initial treatment of choice in patients with recent antibiotic therapy with amoxicillin (previous 30 days) and with resistant H.influenzae infections pending the results of studies of local epidemiology (β-lactamase production ≥15%). The macrolide/azalide class of antibiotics are not recommended routinely for URTIs and are reserved for β-lactam allergic patients.
  
  
  CONCLUSIONS
  The guideline should facilitate rational antibiotic prescribing for URTIs as a component of antibiotic stewardship. However, it requires updating when new information becomes available particularly from randomised controlled trials and surveillance studies of local etiology and antibiotic susceptibility patterns.
authors.affiliation: Ampath National Laboratory Services, Milpark hospital, Parktown, Johannesburg. brinka@ampath.co.za.
authors.forename: Adrian John
authors.initials: AJ
authors.lastname: Brink
authors.forename: Mark
authors.initials: M
authors.lastname: Cotton
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Heather
authors.initials: H
authors.lastname: Finlayson
authors.forename: Raymond
authors.initials: R
authors.lastname: Friedman
authors.forename: Robin
authors.initials: R
authors.lastname: Green
authors.forename: Willy
authors.initials: W
authors.lastname: Hendson
authors.forename: Maurice
authors.initials: M
authors.lastname: Hockman
authors.forename: Gary
authors.initials: G
authors.lastname: Maartens
authors.forename: Shabir
authors.initials: S
authors.lastname: Madhi
authors.forename: Gary
authors.initials: G
authors.lastname: Reubenson
authors.forename: Eddie
authors.initials: E
authors.lastname: Silverbauer
authors.forename: Inge
authors.initials: I
authors.lastname: Zietsman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D009017:Morbidity; D017410:Practice Guidelines as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D013019:South Africa
chemical_list: D000900:Anti-Bacterial Agents