No Antibiotics for Colds, Sore Throats

Two doctor groups are reminding physicians to use antibiotics sparingly this cold and flu season.

The American College of Physicians and the CDC urged doctors not to dole out antibiotics for colds, sore throats, bronchitis, and sinus infections that aren't complicated, according to guidance published in the Annals of Internal Medicine.

"Reducing overuse of antibiotics for acute respiratory tract infections in adults is a clinical priority and a high-value-care way to improve quality of care, lower healthcare costs, and slow or prevent the continued rise in antibiotic resistance," Wayne Riley, MD, MPH, president of ACP, said in a statement.

Antibiotics are prescribed at more than 100 million adult ambulatory care visits every year, and 41% of these prescriptions are for respiratory conditions, the guidance states.

Antibiotic overuse contributes to the spread of antibiotic-resistant infections; in the U.S., there are 2 million antibiotic-resistant illnesses and 23,000 related deaths each year -- costing the healthcare system some $30 billion.

Data from the CDC suggest that about 50% of antibiotic prescriptions are unnecessary or inappropriate, equating to more than $3 billion in excess healthcare costs, the guidance states.

And antibiotics aren't without side effects. Indeed, they are responsible for the largest number of medication-related adverse events, implicated in 1 of every 5 emergency department visits for adverse drug reactions, the researchers said.

To remind physicians about good antibiotic stewardship, ACP and CDC focused on four conditions that most likely will resolve on their own: the common cold, uncomplicated bronchitis, sore throats, and uncomplicated sinus infection.

For uncomplicated bronchitis, physicians shouldn't conduct any tests, and should refrain from prescribing antibiotics, unless pneumonia is suspected. Patients can have cough suppressants, expectorants, antihistamines, decongestants, and beta agonists instead.

A sore throat should get analgesic therapy such as aspirin, acetaminophen, NSAIDs, or throat lozenges -- although testing can be done in patients with symptoms of group A streptococcal pharyngitis. That's the only case in which antibiotics would be warranted, the authors said.

An uncomplicated sinus infection usually resolves without antibiotics, even in patients with a bacterial cause, the guidance states. Patients can have anaglesics for pain and antipyretics for fever.

Antibiotics should be reserved for patients with symptoms lasting more than 10 days, if they start to develop severe symptoms or signs of a high fever (above 39°C/ 102.2°F), or if they have nasal discharge or facial pain that lasts three consecutive days.

By: Kristina Fiore

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