A patient with a common cold should not be prescribed antibiotics, so say two medical bodies in the US, who – in a bid to reduce inappropriate use of antibiotics – have joined forces to advise about appropriate prescribing of antibiotics for acute respiratory tract infections in adults.
The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) issue the new advice in a paper published in the Annals of Internal Medicine.
The purpose of the paper, described as “high-value care advice,” is to amplify and update rather than replace messages from recent guidelines on appropriate antibiotic prescribing, note the authors.
It is aimed at general practitioners and health care professionals who see patients with acute respiratory tract infections (ARTIs) in outpatient settings.
The authors note that ARTIs – such as the common cold, uncomplicated bronchitis, sore throat and sinus infection – are the most common reason for outpatient antibiotic prescriptions for adults in the US.
As a result, they note, inappropriate use of antibiotics for ARTIs contributes significantly to the spread of antibiotic-resistant infections – and the rise of so-called superbugs.
The CDC estimate that every year, at least 2 million people in the US become infected with – and at least 23,000 die as a result of – bacteria that are resistant to antibiotics.
The most common reason patients visit their doctor is because of ARTIs. Unpublished data from the CDC shows that 50% of prescriptions filled for antibiotics in outpatient settings may be inappropriate or unnecessary.
The bill for this misuse comes to over $3 billion – but that is only part of the cost. There are knock-on effects.
For example, antibiotics are the biggest cause of drug-related adverse events, and they are responsible for around 20% of emergency department visits for drug side effects.
The authors recommend doctors do not prescribe antibiotics for patients with the common cold.
Instead, doctors should advise patients that cold symptoms can last for up to 2 weeks and should come back if they take longer to clear up or get worse.
Doctors should also clearly explain that antibiotics are not necessary – and may even give rise to side effects. They should also help the patient understand the pros and cons of taking medications to relieve symptoms.
The paper also covers how to deal with other ARTIs that do not require antibiotics, unless complications are suspected. These include uncomplicated bronchitis, sore throat and uncomplicated sinus infection.
For instance, in the case of uncomplicated bronchitis, it is not necessary to test for or prescribe antibiotics unless pneumonia is suspected. Treatments that can bring symptomatic relief include antihistamines, decongestants, beta-agonists, cough suppressants and expectorants.
In cases of sore throat, doctors should explain that these generally last less than 7 days and mostly do not require antibiotics – which tend to have little effect and bring side effects. To relieve the pain, doctors should recommend patients take analgesics, such as aspirin, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and throat lozenges.
If the doctor suspects the patient has group A streptococcal pharyngitis, they should only prescribe antibiotics if the patient tests positive for the infection (for example, using a rapid strep test and/or a culture test).
And in the case of uncomplicated sinus infections, doctors should reassure patients that they usually get better by themselves without antibiotics – even if they are caused by bacteria. Most patients can get better with supportive care – using, for example, aspirin for pain and fever. They should point out that when patients are prescribed antibiotics for sinus infection, in most cases, the side effects outweigh the benefits.
The paper details special circumstances where persistent or severe sinus infection may warrant antibiotic treatment and urges doctors to reserve them for such less usual occasions.
The paper also suggests doctors make more use of the “symptomatic prescription pad,” such as the CDC’s Symptomatic Relief for Viral Illnesses Prescription Pad. An example can be found on the print materials for health care professionals page of the CDC’s Get Smart: Know When Antibiotics Work website.
The symptomatic prescription is a checklist for the doctor to tick and fill in that tells patients what they can do to relieve symptoms of the viral illness they have been diagnosed with – for example, a cold, cough, sore throat or flu. The doctor ticks the options that apply, adds notes, and gives the “prescription” to the patient.
To emphasize the reason that antibiotics have not been prescribed, the symptomatic prescription clearly states:
“You have been diagnosed with an illness caused by a virus. Antibiotics do not cure viral infections. If given when not needed, antibiotics can be harmful. The treatments prescribed below will help you feel better while your body’s own defenses are fighting the virus.”
The prescription then lists various options for relief, such as drink extra water and juice, use a cool mist vaporizer or saline nasal spray to relieve congestion, and in the case of a sore throat, use ice chips, throat spray and lozenges.
There is also a section where the doctor can list specific relief medicines, and an end section that invites the patient to return within a specified number of days if symptoms persist or worsen, after which the need for antibiotics can be reviewed.
Wayne J. Riley, president of the ACP, comments on the importance of the new guidelines:
“Reducing overuse of antibiotics for ARTIs in adults is a clinical priority and a high-value care way to improve quality of care, lower health care costs and slow and/or prevent the continued rise in antibiotic resistance.”
Meanwhile, in the race against time to find new antimicrobial drugs, scientists are turning to drugs already approved for other uses as a possible resource. Medical News Today described an example of this in December 2015, when a team from the University of Illinois at Urbana-Champaign reported finding antibiotic properties in a group of anti-parasitic drugs known as uncouplers.