Antibiotic Prescribing Recommendations for Retail Clinicians

Acute upper respiratory tract infections (URTIs) are among the most common complaints from patients seeking care at retail clinics, but clinicians should exercise caution in prescribing antibiotics to treat these illnesses.

In a new paper, the American College of Physicians (ACP) and the US Centers for Disease Control and Prevention (CDC) cited that antibiotics are frequently overprescribed for many acute URTIs—including sinus infections, bronchitis, and the common cold—even though patients with these conditions generally get better on their own without antibiotics.

Based on these findings, the ACP and CDC made the following recommendations on appropriate antibiotic use, which retail clinicians to consider when treating patients with URTIs:

1. Patients with bronchitis should not be started on antibiotic therapy or tested unless clinicians suspect that pneumonia.
2. Patients with symptoms suggestive of group A streptococcal pharyngitis—such as persistent fever, anterior cervical adenitis, and tonsillopharyngeal exudates—should be tested via rapid antigen detection and/or culture tests for Group AStreptococcus. Only those with confirmed cases of streptococcal pharyngitis should be prescribed antibiotics.
3. Patients with acute rhinosinusitis should be treated with antibiotics only if they experience:

• Symptoms that persist for more than 10 days,
• An onset of severe symptoms or signs of high fever (>39 °C), along with purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or
• An onset of worsening symptoms following a viral illness that lasted 5 days and was initially improving.

1. Patients with the common cold should not be prescribed antibiotics.

The ACP and CDC warned that antibiotic overuse could have significant consequences, given that antibiotics are responsible for 1 of every 5 emergency room visits related to adverse drug reactions. Unpublished data from the CDC also suggest that up to 50% of antibiotic prescriptions areunnecessary or inappropriatein the outpatient setting.

Another potential consequence alarming many health care professionals is the possibility that some diseases will grow resistant antibiotics as a result of their overuse. This concern has sparked legislative efforts to curbantibiotic resistance, including the 5-year National Action Plan for Combating Antibiotic-Resistance Bacteria, anexecutive actionsigned by President Obama in September 2014.

“Advanced practice clinicians in the retail setting should keep the issue of overprescribing antibiotics in the forefront of their mind,” PharmD candidate Erin Drewnianypreviously wrote. “Clinicians should pay close attention to antibiotic prescribing guidelines to ensure they are writing prescriptions for antibiotics only when necessary.”

In emphasizing the importance ofantibiotic stewardship, the ACP and CDC ultimately encouraged clinicians to use their best judgment when prescribing these medications.

“Although it is everyone's responsibility to use antibiotics appropriately, providers have the power to control prescriptions,” the study authors concluded. “Reducing inappropriate antibiotic prescribing will improve quality of care, decrease health care costs, and preserve the effectiveness of antibiotics.”

The recommendations were published in theAnnals of Internal Medicine.