n CME : Your SA Journal of CPD - Treatment of common respiratory infections : the antibiotic dilemma : main topic




Antibiotic over-prescribing for acute upper respiratory tract infections (URTIs) is common and promotes antibiotic resistance. <br> In patients without underlying comorbidity the majority of URTIs will resolve spontaneously. Patient satisfaction is related to the quality of the doctor-patient interaction rather than to receiving an antibiotic prescription. <br> Mucoid sputum or nasal discharge in itself is not an indication for an antibiotic. <br> Acute bacterial sinusitis can be diagnosed 7 - 10 days after an URTI, when nasal discharge becomes purulent and congestion persists, and is associated with facial pain worsened by bending forward. A history of sinus surgery or nasal polyps suggests that the patient may develop sinusitis more readily, especially if the discharge is bloodstained. <br> Patients with acute bronchitis and severe underlying lung disease or co-morbidity may benefit from being treated early with an antibiotic to prevent pneumonia or to limit ongoing lung damage. <br> Sputum culture and sensitivity testing allow rational antibiotic selection for patients with structural lung disease (chronic bronchitis, emphysema and bronchiectasis) and recurrent respiratory tract infections.


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