CDC, American College of Physicians issue new guidelines on antibiotic prescription

Addressing physician mishandling of antibiotic testing and prescription is a key focus of new clinical guidelines for antibiotic stewardship issued by the CDC in partnership with the AmericanCollege of Physicians. The guidelines are published in the Annals of Internal Medicine.

The paper includes four pieces of "high-value care advice:"

  1. Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
  2. Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
  3. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>102.2 °F) and purulent nasal discharge or facial pain lasting for at least three consecutive days, or onset of worsening symptoms following a typical viral illness that lasted five days that was initially improving (double sickening).
  4. Clinicians should not prescribe antibiotics for patients with the common cold.

"Inappropriate use of antibiotics for acute respiratory tract infections is an important factor contributing to the spread of antibiotic-resistant infections, which is a public health threat," ACP president Wayne Riley, MD, said in a news release accompanying the 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."

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