Antibiotics for acute respiratory tract infections in primary care

Primary care is increasingly becoming the focus of antimicrobial stewardship in the fight against the global crisis of antibiotic resistance. This is where the greatest tonnage of antibiotics is prescribed—perhaps three quarters of all used in medical care. Respiratory tract infections are the group of infections most commonly treated with antibiotics, principally made up of otitis media, sore throat, cough (“acute bronchitis”), rhinosinusitis, and undifferentiated infections.

Among this group, however, the antibiotic trade-off between benefits and costs—counting resistance among the latter—is least favourable. Respiratory tract infections are spontaneously remitting illnesses often caused by viruses, although it is difficult or even impossible to differentiate viral from bacterial cases in primary care. Strong evidence from Cochrane reviews shows that antibiotics on average reduce the duration of illness by less than a day.1 2 3 4 Accordingly we should conserve antibiotics in primary care so that resistance—which is directly amplified by antibiotic use—is minimised, and even reversed.5 An apparently simple solution would be to explain clearly …