Primary care challenges in the management of respiratory tract infections.

Community-acquired respiratory tract infections (RTIs), such as community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute rhinosinusitis, are among the most common reasons that adults seek care from their primary health care providers in the United States. High levels of pneumococcal resistance have developed, particularly to macrolides, since the 1990s. Empiric management of these infections, the difficulty in differentiating bacterial from nonbacterial infection, and a high level of patient expectation of antimicrobial therapy contribute to the overuse of antibiotics. The primary care clinician must judiciously weigh various factors in order to prescribe appropriate and effective treatment.