Health experts issue "Principles for Appropriate Antibiotic Use" for adults with upper respiratory infections

Increasingly concerned about the health threats from excessive antibiotic use, CDC convened a panel of national health experts to develop best treatment guidelines for adults with colds and acute upper respiratory infections. The guidelines, "Principles for Appropriate Antibiotic Use," were released today in the Annals of Internal Medicine and target the overuse or misuse of antibiotics.

Typically, the best treatment for otherwise healthy adults with acute bronchitis, colds and most types of sore throats is to simply help alleviate symptoms, according to the new principles. According to physicians from specialties in internal medicine, family medicine, emergency medicine and infectious disease, who made up the panel, all too often antibiotics are prescribed for adults with upper respiratory infections caused by viruses, which do not respond to antibiotics meant to treat bacterial infections.

Research indicates that 75 percent of antibiotics prescribed in outpatient settings are for respiratory infections. Each year in the United States, an estimated 50 million antibiotic prescriptions are for illnesses such as colds or flu for which antibiotics offer no benefit. The majority of antibiotics prescribed for adults in outpatient settings for acute respiratory infections such as sinusitis, pharyngitis, bronchitis and the common cold, offer little or no benefit to the patient. In addition, treating viral acute respiratory infections with antibiotics promotes the spread of antibiotic-resistant bacteria.

The American Academy of Family Physicians (AAFP), the American College of Physicians - American Society of Internal Medicines (ACP-ASIM), and the Infectious Disease Society of America (IDSA) contributed to the new guidelines. To curtail the rise of community-acquired antibiotic resistant infections, CDC, AAFP, ACP-ASIM, and IDSA collaborated on the principles to provide medical clinicians strategies to encourage antibiotic use for those patients most likely to benefit from them.

"By promoting a better understanding of the appropriate use of antibiotics, we are attempting to change the entire culture around which antibiotics are prescribed," said Health and Human Services Secretary Tommy G. Thompson. "We are working toward a day when a patient or parent sees his or her health care provider and rather than requesting an antibiotic, asks for the best treatment available."

The excessive use of antibiotics among outpatients has contributed to the emergence and spread of antibiotic-resistant bacteria in many communities. Increasing antibiotic resistance among common pathogens is leaving fewer effective drugs available to treat infectious diseases. When resistance develops in first-line drugs, the remaining alternative drugs may be less effective, more expensive and more difficult to administer. The resistant pathogens are a growing menace to all people, regardless of age, sex, or socioeconomic background.

"When health care providers use these principles they can greatly reduce the health threats caused by excessive antibiotic use," said Jeffrey Koplan, M.D., Director of the Centers for Disease Control and Prevention. "The best course of action for individuals and the community is to prescribe antimicrobial therapy only when beneficial to a patient, target that therapy to the pathogen, and use the appropriate drug at the right dose and duration."

The principles help focus on the major decisions a physician faces during the routine evaluation of a patient with an acute respiratory illness According to the panel, major decisions relating to the management of acute respiratory infections tend to center on 1) diagnosis, 2) likelihood it's caused by a bacteria, and 3) whether and for whom antibiotic therapy should be prescribed. The principles are meant for evaluating otherwise healthy adults. For example, the guidelines state that the evaluation of adults with an acute cough illness, possible acute bronchitis, should focus on ruling out pneumonia. Routine antibiotic treatment of uncomplicated acute bronchitis is not recommended, regardless of the duration of cough. Patient satisfaction, the report notes, is most dependent on the doctor-patient communication, rather than on whether or not an antibiotic is prescribed.

"A key element in the CDC's strategy to reduce overuse of antibiotics is to have reliable, evidence-based practice principles for physicians," said CDC's Richard Besser, M.D., and panel member. "These guidelines are just one part of CDC's overall effort to reduce the overuse of antibiotics."

On Jan. 18, 2001, CDC and nine other federal agencies released A Public Health Action Plan to Combat Antimicrobial Resistance–a blueprint for federal actions to address the emerging threat of antimicrobial resistance, including the appropriate use of antibiotics. The principles released today fulfill part of a top priority in the action plan, to develop interventions to assist clinicians in appropriate prescribing of antimicrobials.

For more information about antimicrobial resistance, including the overuse or misuse of antibiotics, visit CDC websites: http://www.cdc.gov/drugresistance/actionplan/index.htm; http://www.cdc.gov/drugresistance/index.htm

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