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Rational use of Antibiotics in Respiratory Tract Infections

Key Messages Respiratory infections PDF
Rational use of Antibiotics in Upper Respiratory Tract Infections
Rational use of Antibiotics in Lower Respiratory Tract Infections in Adults
Rational use of Antibiotics in Lower Respiratory Tract Infections in Children

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Key Points

Rational Use of Antibiotics in Respiratory Tract Infections

“The prevalence of antibiotic resistance in a country reflects the local consumption of antibiotics. The majority of antibiotics are prescribed in general practice and most prescriptions are attributable to treatment of respiratory tract infections.” (Bjerrum, 2004).

General principles of rational antibiotic use

  • Avoid prescribing antibiotics for viral infections.
  • When antibiotics are indicated, choose the appropriate dose and duration of an effective agent with the narrowest spectrum, fewest side effects and lowest cost.

Application of these principles to the treatment of respiratory tract infections would result in no prescribing of antibiotics for viral infections such as the common cold and a selection between penicillin V, amoxicillin or erythromycin as first line therapy for most bacterial respiratory infections. This would reduce the development of organisms resistant to second line agents, reduce national prescribing costs, and reduce adverse effects to antibiotics without compromising patient care.


New Zealand general practitioners have done well in moving toward more rational antibiotic use. Rational use of antibiotics reduces resistance rates for the community as a whole (Molstad, 1999, Hefferman, 2002). It also importantly reduces the likelihood of individuals developing resistant bacteria. People who take antibiotics have increased risk of developing resistant strains of bacteria, for example a resistant strain of pneumococcus in their nasopharynx (Dowell, 1998).

The situation here in New Zealand is unlike an American study, which reported that 46% of patients presenting to doctors with the common cold were prescribed antibiotics for this viral infection. Worse, 51% of the antibiotics used were broad-spectrum (Steinman, 2003). Never the less, there were three quarters of a million prescriptions for amoxicillin-clavulanate (Augmentin®) in New Zealand in 2005 (Pharmhouse data).

Even when antibiotics are indicated, the use of broad-spectrum antibiotics such as amoxicillin-clavulanate, second generation macrolides, cephalosporins and quinolones as first line therapy for respiratory tract infections encourages the development of resistant strains and substantially adds to costs.

When a person takes an antibiotic to treat an illness, the drug kills susceptible bacteria. This leaves bacteria that can resist it - resistant bacteria. With the reduced competition, resistant bacteria can increase their numbers exponentially, to become predominant. Broad-spectrum antibiotics kill a wide-range of bacteria allowing resistant strains which were previously an insignificant minority to predominate.

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