When are antibiotics needed for acute respiratory tract infections?

I think a lot of us do not like to take medications. Whenever, we are sick, we are not sure if we should see a doctor. This is because our immune system can help us overcome infections when our body is strong. Even doctors, can be in a dilemma as when antibiotics should be prescribed for their patients.

This interesting article touches on the various types of acute respiratory infections and excerpts are reproduced below:

COMMON RESPIRATORY TRACT INFECTIONS

The most common viral ARI is an upper respiratory tract infection (URI), also known as the common cold. Most URIs are caused by viruses, with rhinovirus, parainfluenza virus, coronavirus, adenovirus, respiratory syncytial virus, and influenza virus accounting for most cases.

Influenza is a systemic illness that involves the upper respiratory tract and should be differentiated from other ARIs, particularly during the months when the influenza virus is circulating. Influenza in adults is differentiated by acute onset, significant fever, and marked myalgias. Rapid antigen tests are available for diagnosing influenza, and antiviral therapy may be appropriate for certain patients.

Antibiotic treatment does not improve resolution of influenza infections or prevent complications. Only a small proportion of URIs become complicated by bacterial sinusitis or pneumonia; in these few cases, antibiotics may be useful. Most cases of uncomplicated URI resolve spontaneously within 1 to 2 weeks and require no treatment.

Acute sinusitis

Obstruction of the sinus ostia after a URI may result in rhinosinusitis or acute sinusitis. Bacterial and viral rhinosinusitis are difficult to differentiate clinically, and overdiagnosis of acute bacterial rhinosinusitis is common. The presence of yellow or green purulent secretions from the nares or throat, by itself, does not differentiate between a bacterial and a viral infection.

Generally, the diagnosis of acute bacterial sinusitis in adults should be reserved for patients who have symptoms for 7 days or longer, purulent nasal secretions, and maxillary facial or tooth pain. Symptomatic therapy is the preferred initial management for mild cases; the most narrow-spectrum antibiotic active against the likely pathogens, Streptococcus pneumoniae and Haemophilus influenzae, should be prescribed for patients with severe disease regardless of duration.

The dilemma in the treatment of URIs and sinusitis is the lack of a simple and accurate diagnostic test that reliably identifies rhinosinusitis; therefore, a clinical diagnosis is uncertain.

Pharyngitis

Many office visits to primary care providers are for pharyngitis. Viruses are the most common cause of acute pharyngitis, and the condition should be managed with supportive therapy that includes analgesics, antipyretics, and gargle.11 Group A streptococci (GAS) cause 15% to 30% of cases of acute pharyngitis in pediatric patients and 5% to 10% of cases in adults.

Patients infected with GAS, and a few other uncommon bacteria, will benefit from antibiotic therapy; therefore, the clinical goal is to identify those patients with a high probability of GAS infection. The most reliable indicators are fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of a cough.

Patients with two or more of these features (referred to as the Centor criteria) are candidates for antigen testing or culture; patients with fewer than than two criteria do not need to be tested as they are less likely to be infected with GAS. Clinicians may choose to treat patients with at least three of the four clinical criteria empirically with antibiotics. Penicillin is the treatment of choice for pharyngitis caused by a GAS infection.

Acute bronchitis

This ARI manifests as a cough with or without sputum production and lasts for up to 3 weeks. Chest radiography findings are normal. Respiratory viruses are the cause of most cases of uncomplicated acute bronchitis; however, pneumonia must be considered in the differential diagnosis when patients present with an acute cough illness.

Signs of pneumonia include fever, cough, tachypnea, tachycardia, and evidence of consolidation on chest auscultation. The presence of purulent sputum is not predictive of bacterial infection. Patients with uncomplicated bronchitis may benefit from beta-agonist inhalers and antitussives. Acute bronchitis, like other ARIs, usually does not require antibiotic therapy.

Many people have had good sinus health once they adopted nasal irrigation. Nasal irrigation with a neti pot can help prevent one from catching the common cold and reduce the incidents of catching viral influenza.

For more information, visit Sinus Infection Help.