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Most respiratory infections don't require antibotics, new guidelines advise

New guidelines suggest sharp cutback on antibiotic prescriptions for respiratory infections.
/ Source: TODAY

With drug-resistant bacteria on the rise, doctors’ groups have issued new advice on when antibiotics should be prescribed for respiratory infections. The hope is that the guidelines, issued by Centers for Disease Control and Prevention and the American College of Physicians, will stop overprescribing.

“Inappropriate use of antibiotics for ARTIs [Acute Respiratory Tract Infections] is an important factor contributing to the spread of antibiotic resistant infections, which is a public health threat,” said Dr. Wayne J. Riley, president of the ACP and an adjunct professor of healthcare management at Vanderbilt University.

Over 41 percent of the 100 million prescriptions written during adult outpatient visits are for respiratory infections. The CDC estimates that 50 percent of those prescriptions may be unnecessary or inappropriate.

And it’s not just worries about antibiotic resistant bugs that has experts concerned. Antibiotics are responsible for the largest number of medication-related adverse events and have been implicated in one out of every five visits involving drug reactions to the emergency room.

Related: What NOT to do if you have the flu

So, when should doctors be prescribing antibiotics to patients with respiratory infections? Dr. Natalie Azar explains when it’s appropriate for patients to get these medications.


Patients should receive antibiotics if bacterial pneumonia or a strep throat is confirmed.

Symptoms that suggest a patient might have strep include:

  • A sore throat that usually starts quickly and can cause severe pain when swallowing
  • Fever (101°F or above)
  • Red and swollen tonsils, sometimes with white patches or streaks of pus
  • Tiny, red spots (petechiae) on the roof of the mouth
  • Headache, nausea, or vomiting
  • Swollen lymph nodes in the front of the neck
  • Sandpaper-like rash

Doctors may suspect — and test for— bacterial pneumonia if certain symptoms are present including:

  • Fever, sweating, shaking and chills
  • Cough, which may produce phlegm
  • Chest pain when you breathe or cough
  • Shortness of breath
  • Fatigue
  • Nausea, vomiting or diarrhea

Before prescribing a particular drug, your doctor will try to identify which bacteria are causing your symptoms.


While doctors have in the past prescribed antibiotics for sinus infections, the new guidelines suggest that this should change. Uncomplicated sinus infections usually resolve without antibiotics even when the cause is bacterial.

Antibiotics should be prescribed if your symptoms persist for more than 10 days, if your symptom onset is severe, if there is a fever higher than 102.2 F with nasal discharge or facial pain lasting for at least three consecutive days or if there is a worsening of symptoms following a viral illness that was initially improving.


Bronchitis alone does not require antibiotics, Azar said, adding that doctors should prescribe antibiotics only if pneumonia is suspected. This may come as a big surprise to many patients. Currently two thirds of patients diagnosed with bronchitis are treated with antibiotics, even though 90 percent of cases are caused by viruses which don’t respond to antibiotics.

The best course in case of bronchitis is to try to relieve symptoms through the following methods:

  • Drink plenty of fluids.
  • If you have asthma or another chronic lung condition, use your inhaler.
  • Get plenty of rest.
  • Take aspirin or acetaminophe if you have a fever. Aspirin should not be given to children.
  • Use a humidifier or steam in the bathroom.


No antibiotics should be prescribed for patients with a cold. Symptoms normally resolve within two weeks, but if they don’t or if they worsen it’s time to see your doctor.

Once again, the best way to treat a cold is to target specific symptoms.

For patients with sore throat, pain medications such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges, can help.

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