Responsible prescribing for upper respiratory tract infections

Upper respiratory tract infections (URTIs) are responsible for a large amou nt of community antibacterial use worldwide. Recent systematic reviews have demonstrated that most URTIs resolve naturally, even when bacteria are the cause. The high consumer expectation for antibacterials in URTIs requires intervention by the general practitioner and a number of useful strategies have been developed. Generic strategies, including eliciting patient expectations, avoiding the term 'just a virus', providing a value-for-money consultation, providing ve rbal and written information, empowering patients, conditional prescribing, directed education campaigns, and emphasis on symptomatic treatments, shou ld be used as well as discussion of alternative medicines when relevant. The various conditions have differing rates of bacterial infection and requ ire different approaches. For acute rhinitis, laryngitis and tracheitis, vi ruses are the only cause and, therefore, antibacterials are never required. In acute sore throat (pharyngitis) Streptococcus pyogenes is the only impo rtant bacterial cause. A scoring system can help to increase the likelihood of distinguishing a streptococcal as opposed to viral infection, or altern atively patients should be given antibacterials only if certain conditions are fulfilled. Strategies for treating acute otitis media vary in different countries. Most favour the strategy of prescribing antibacterials only whe n certain criteria are fulfilled, delaying antibacterial prescribing for at least 24 hours. In otitis media with effusion, on the other hand, there is no primary role for antibacterials, as the condition resolves naturally in almost all patients aged >3 months. Detailed strategies for acute sinusiti s have not been worked out but restricting antibacterial prescribing to cer tain clinical complexes is currently recommended by several authorities bec ause of the high natural resolution rate.