Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: Background, specific aims, and methods

The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneum oniae. The majority of antibiotics prescribed to adults in ambulatory pract ice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including t he common cold). For each of these conditions-especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routin e antibiotic treatment is not recommended)-a large proportion of the antibi otics prescribed are unlikely to provide clinical benefit to patients. Beca use decreasing community use of antibiotics is an important strategy for co mbating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physici ans representing the disciplines of internal medicine, family medicine, eme rgency medicine, and infectious diseases to develop a series of "Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Inf ections in Adults." These principles provide evidence-based recommendations far evaluation and treatment of adults with acute respiratory illnesses. This paper describes the background and specific aims of and methods used t o develop these principles. The goal of the principles is to provide clinic ians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements t o the health care delivery system that facilitate nonantibiotic treatment o f the conditions in question.