Abstract
IntroductionBacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections.ObjectivesTo review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality.MethodsA literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists.ResultsAntibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into ‘consideration’.ConclusionsPeriodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians’ and patients’ behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.
Highlights
Bacterial resistance to antibiotics in infectious processes has been increasing in recent years and has become a serious public health problem.[1]In October 2017, the World Health Organization (WHO) stated that bacterial resistance to antibiotics is one of the main health problems worldwide, as it prolongs hospital length of stay, increases treatment costs and, even more seriously, considerably increases mortality related to infectious diseases.[2]
Approximately 50% of all antibiotic prescriptions aim at the treatment of upper respiratory infections, especially rhinosinusitis, suppurative acute otitis media, and acute pharyngotonsillitis.[4]
The abusive and indiscriminate use of antibiotics on a global scale has led to a growing concern in all health area sectors
Summary
Bacterial resistance to antibiotics in infectious processes has been increasing in recent years and has become a serious public health problem.[1]. The pain improvement promoted by the antibiotic is very discrete, of around 16 h only, so the NNT is very high, not justifying its use as a generalized primary purpose in pain control or in the prevention of suppurative complications.[36,37] despite certain divergences between different international recommendations, there is evidence recommending the systematic treatment of all cases of pharyngotonsillitis caused by S. pyogenes, due to its good cost-benefit ratio for the primary prevention of rheumatic fever. In some cases of bacterial pharyngotonsillitis with a presentation that is not characteristic of S. pyogenes, the possibility of other bacteria, such as Group C and G Streptococcus, H. influenzae, Moraxella catarrhalis, S. aureus, Neisseria gonorrhoeae, Fusobacterium nucleatum + Borrelia vincentii (Plaut-Vincent angina) must be considered In those situations, when antibiotics are required, those with a broad coverage spectrum should be used, such as amoxicillin, amoxicillin-clavulanate or third-generation cephalosporins (Table 9).
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