3.
Avoid prescribing antibiotics for upper respiratory tract infection.
Most uncomplicated upper respiratory infections are viral in aetiology and antibiotic therapy is not indicated. Oral antibiotic therapy of presumed URTI in febrile young infants is not only 'low value' but can be actively dangerous, in delaying presentation to hospital (inappropriately reassuring parents and confounding investigations of sepsis). This is a major issue for paediatrics primary care and ED presentations. Patient education is an important component of management together with symptomatic treatment.
Infections with Streptococcus pyogenes and Bordetella pertussis do require antibiotic therapy.
Supporting evidence
- Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Systemic Review 2013; CD000247.
- Hersh AL, Jackson MA, Hicks LAl. Principles of judicious antibiotic prescribing for upper respiratory tract infections in paediatrics. Paediatrics 2013;132(6):114654.
- Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.
How this list was made
An initial list of 10 low value interventions was compiled by the Lead Fellow of the Australasian Society for Infectious Diseases (ASID) Inc following an online discussion in ASID's discussion forum, Ozbug. The Royal Australasian College of Physicians (RACP) then facilitated a consultation of all ASID members via a survey distributed through the society’s e-newsletter. In the survey, members were asked to rank the 10 suggested interventions and suggest additional items for consideration. A subsequent shortlist of items was created by selecting the top 7 interventions as ranked by the members from the initial list.
The shortlist was sent to ASID’s special interest groups and selected members who had agreed to assist, who were asked to recommend the items to comprise the ‘top 5’. This final list was endorsed by ASID Council on 31 July 2015. The Top 5 was then circulated again to the ASID members for final comments before being signed off by ASID’s Executive Committee.
- 1 Do not use antibiotics in asymptomatic bacteriuria.
- 2 Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection.
- 3 Avoid prescribing antibiotics for upper respiratory tract infection.
- 4 Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms.
- 5 In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology.