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Principles of Appropriate Antibiotic Use for Treatment of Nonspecific Upper Respiratory Tract Infections in Adults: Background
- Ralph Gonzales, MD, MSPH;
- John G. Bartlett, MD;
- Richard E. Besser, MD;
- John M. Hickner, MD, MSc;
- Jerome R. Hoffman, MD, MA; and
- Merle A. Sande, MD
- From the University of Colorado Health Sciences Center, Denver, Colorado; Johns Hopkins University, Baltimore, Maryland; Centers for Disease Control and Prevention, Atlanta, Georgia; University of California, Los Angeles, Los Angeles, California; Michigan State University, East Lansing, Michigan; and University of Utah, Salt Lake City, Utah.
Abstract
The following principles of appropriate antibiotic use for adults with nonspecific upper respiratory tract infections apply to immunocompetent adults without complicating comorbid conditions, such as chronic lung or heart disease.
1. The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms, although frequently present, are not prominent.
2. Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended. Studies specifically testing the impact of antibiotic treatment on complications of nonspecific upper respiratory tract infections have not been performed in adults. Life-threatening complications of upper respiratory tract infection are rare.
3. Purulent secretions from the nares or throat (commonly observed in patients with uncomplicated upper respiratory tract infection) predict neither bacterial infection nor benefit from antibiotic treatment.
Article and Author Information
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*After the primary author (Dr. Gonzales), authors are listed in alphabetical order.
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In addition to the Centers for Disease Control and Prevention, the principles outlined in this document have been endorsed by the American Academy of Family Physicians, the American College of Physicians–American Society of Internal Medicine, and the Infectious Diseases Society of America.
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Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.
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Acknowledgments: External review has included feedback from the Centers for Disease Control and Prevention; the American College of Physicians–American Society of Internal Medicine Clinical Efficacy Assessment Subcommittee; and representatives of the American Academy of Family Practitioners, the American College of Emergency Physicians, and the Infectious Diseases Society of America.
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Role of the Funding Source: Partial support for the development of the Principles was provided by the Centers for Disease Control and Prevention, and final approval by the Centers for Disease Control and Prevention of all manuscripts submitted for publication was required.
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Requests for Single Reprints: Richard E. Besser, MD, Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, rbesser{at}cdc.gov.
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Current Author Addresses: Dr. Gonzales: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262.
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Dr. Bartlett: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 463A, Baltimore, MD 21287-0003.
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Dr. Besser: Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
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Dr. Hickner: Department of Family Practice, Michigan State University, B-111 Clinical Center, East Lansing, MI 48824.
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Dr. Hoffman: UCLA Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024.
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Dr. Sande: Department of Medicine (4C104), University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132.
- Copyright ©2004 by the American College of Physicians
