Appropriate Antibiotic Use for Treatment of Nonspecific Upper Respiratory Infections, Rhinosinusitis, and Acute Bronchitis in Adults

Acute sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections (URIs) account for the majority of antibiotics prescribed by primary care physicians in the United States. The emergence of antibiotic-resistant bacteria in the community setting is now an issue for individual patients as well as society at large, and it is the responsibility of all clinicians to limit antibiotic treatment to those patients who are most likely to benefit from it. The vast majority of acute respiratory infections are caused by viruses. Antibiotic treatment of patients with these infections selects for resistant nasopharyngeal bacteria, acutely increasing the spread of resistant pathogens through secretions and predisposing the treated patient to more serious bacterial infections in the future. The guidelines summarized in this chapter were designed by a panel of physicians representing family medicine, internal medicine, emergency medicine, and infectious diseases to provide a practical approach to the appropriate diagnosis and treatment of previously healthy adults with nonspecific URI, acute sinusitis, or acute bronchitis in the ambulatory care setting. Recommendations for the diagnosis and treatment of pharyngitis are provided in a separate chapter.