Lower respiratory tract infections;a review of the literature 17 Lower respiratory tract infections; a review of the literature 2.1 Introduction. Upper Respiratory Tract Infection What is an upper respiratory tract infection? Infections of the throat (larynx), or the main airway (trachea), or the airways going.

Focus of This Summary This is a summary of a evaluating the evidence regarding the effectiveness and adverse consequences of strategies for reducing antibiotic use in adults and children with uncomplicated acute respiratory tract infections (RTIs). The systematic review included 133 unique studies published from 1990 to February 2015. Although this summary provides a review of evidence, it should not be construed to represent clinical recommendations or guidelines. Background In the United States, at least 2 million people are infected with antibiotic-resistant bacteria each year, causing approximately 23,000 deaths. A key factor for the increased rate of antibiotic resistance is high outpatient consumption of antibiotics. Antibiotics are frequently inappropriately used for uncomplicated acute RTIs. For the purpose of this summary, include acute bronchitis, acute otitis media, pharyngitis/tonsillitis, rhinitis, sinusitis, influenza, and various viral syndromes but not community-acquired pneumonia or acute exacerbations of chronic obstructive pulmonary disease, bronchiectasis, or other chronic underlying lung diseases.

Deciding whether to prescribe antibiotics for acute RTIs is a complex process. Guidelines generally recommend withholding antibiotic treatment for most uncomplicated acute RTIs, with certain exceptions such as Group A streptococcus pharyngitis or severe sinusitis. Desh Bhakti Geet Pdf. Nevertheless, most outpatient antibiotic prescriptions in the United States are for acute RTIs. The factors associated with overuse of antibiotics for uncomplicated acute RTIs are numerous and diverse. These factors include patient demographics (e.g., children vs.

Adults); patient and clinician preferences and communication; patient expectations and physician perception of patient expectations; clinician specialty, knowledge, and experience; clinical inertia; geographic location; clinic type; availability of followup care; and feedback from infectious disease experts. Consequently, vary in targets and designs. Interventions include clinical strategies (e.g., use of point-of-care diagnostic tests, delayed antibiotic prescribing), system-level strategies (e.g., electronic decision support), education (e.g., strategies to improve communication between clinicians and patients, public education campaigns), and multifaceted approaches that incorporate various elements.

See in the Appendix for further explanations and examples of these interventions. Improving antibiotic prescribing has become an urgent public health priority. May achieve various potential outcomes, including slowed evolution of antibiotic resistance, decreased health care costs, and fewer adverse drug events. The systematic review summarized herein assesses the effectiveness and adverse consequences of possible strategies for reducing antibiotic use in adults and children with acute RTIs.

Conclusions Current evidence supports the use of procalcitonin point-of-care testing in adults, specific education interventions for patients/parents and clinicians, and electronic decision support to reduce overall antibiotic prescribing (and, in some cases, improve appropriate prescribing) without increasing the risk of adverse consequences, although the reduction in prescribing varied widely. Additional interventions were also effective in reducing antibiotic prescribing, but evidence on adverse consequences of these interventions was lacking, insufficient, or mixed. While procalcitonin point-of-care testing reduced antibiotic prescribing in adults, use of an adult algorithm for procalcitonin testing in children increased antibiotic prescribing and adverse consequences. Other point-of-care tests (such as the rapid strep test, multi-viral polymerase chain reaction [PCR] in adults, and C-reactive protein [CRP] testing) reduced antibiotic prescribing, but evidence on adverse consequences associated with these tests either showed an increase in some adverse outcomes or was unavailable. Delayed prescribing reduced antibiotic prescribing but also reduced patient satisfaction and increased persistence of symptoms.