title: Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention.
abstract: BACKGROUND
  Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.
  
  
  METHODS
  A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold."
  Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
  Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
  Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
  Clinicians should not prescribe antibiotics for patients with the common cold.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Harris
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
authors.forename: Amir
authors.initials: A
authors.lastname: Qaseem
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy; D003139:Common Cold / Q000188:drug therapy; D019317:Evidence-Based Medicine; D006801:Humans; D057970:Inappropriate Prescribing; D010612:Pharyngitis / Q000188:drug therapy; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012220:Rhinitis / Q000188:drug therapy; D012852:Sinusitis / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D013297:Streptococcus pyogenes; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents