Antibiotic Treatment of URTI

Other URTIs

Antibiotic Treatment of URTI

·        See also Acute Otitis Media (Topic)

·        Treatment for Strep Pharyngitis (Path lecture):

o  Oral Penicillin:

§  On empty stomach (before food)

§  500 mg (200 for kids) 8 hourly for 10 days (adults)

§  If compliance in doubt, IM benzathine penicillin G (single dose)

o  Allergic to Penicillin: Erythromycin 500 mg (200 for kids) 8 hourly for 10 days

·        Antibiotic treatment (source –„ Just Say No‟, Thomas and Arroll, NZMJ, 14 July 2000):

o  No benefits in patients with colds

o  Trivial benefit in patients with acute bronchitis

o  Trivial benefit in all but a minority of patients with acute exacerbations of COPD

o  Modest benefit in sinusitis

o  But, in real life, antibiotics are prescribed for a majority of patients with URTI

·        Antibiotic treatment (Cochrane review):

o  Absolute benefits modest

o  Preventing complications can only be achieved by treating many who will derive no benefit

o  Symptoms: reduced duration by about half a day, especially at 3 days (although 50% of untreated had also settled by then)

o  Non-suppurative complications: Reduces rheumatic fever to less than one third. Possible protection against acute glomerulonephritis (although rare)

o  Suppurative complications: Reduces rate of otitis media to a quarter (NNT = 29), acute sinusitis to about one half and reduced incidence of quinsy

·        No risk of delaying antibiotic treatment for possible Strep Pyogenes pharyngitis until culture results received. Late treatment as effective as early treatment

·        Risks of „over treatment‟ with antibiotics: Penicillin resistance – 2 to 9 times, ­ risk of subsequent otitis media, pneumonia, bacteraemia or meningitis being caused by resistant S. Pneumoniae. „Cherish your normal flora and don‟t assault it with antibiotics‟

·        Delayed/contingent prescription can allow ¯antibiotics without ­morbidity. Eg antibiotics dispensed for sore throat dropped from 99% to 31% with wait of 2 days

·        For Treatment of Otitis Media, see Acute Otitis Media(Topic)