Large-scale reduction of antibiotic prescriptions requires a multidimensional approach, combining clinician, patient, and public education, according to updated clinical guidelines issued by the American College of Physicians (ACP) and the CDC and published January 19 online ahead of print in the Annals of Internal Medicine.

The guidelines, co-authored by Aaron M. Harris, MD, MPH, and Lauri A. Hicks, DO, of the CDC, and Amir Qaseem, MD, PhD, MHA, of the ACP, serve as an update of the 2001 guidelines, Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections In Adults. Following a narrative literature and evidence review relating to appropriate antibiotic use in the case of acute respiratory tract infection (ARTI) – including acute uncomplicated bronchitis, pharyngitis, rhinosinusitis, and the common cold – the researchers developed four points of High­-Value Care Advice:

High-Value Care Advice 1: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.

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High-Value Care Advice 2: Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.

High-Value Care Advice 3: Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms, or signs of high fever (>39°) and purulent nasal discharge or facial pain lasting at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).

High-Value Care Advice 4: Clinicians should not prescribe antibiotics for patients with the common cold.