Reduction in antibiotic prescribing for respiratory tract infections is needed!

In general practice, approximately 25% of consultations are related to infectious diseases. The emergence and spread of resistant bacteria are related to antibiotic use on an individual and on a community level. Antibiotic prescribing differs profoundly from one European country to the next, though there is no evidence of differences in the prevalence of infectious diseases. Most respiratory tract infections are self-limiting conditions, and recent evidence shows that antibiotics only slightly modify the course of most respiratory tract infections. The general practitioner should focus on patients with more severe symptoms who might benefit more from antibiotic treatment. In general, antibiotics should be prescribed for acute pneumonia. In addition, we may offer antibiotics to a selected group of patients with more severe symptoms of maxillary sinusitis, pharyngotonsillitis and acute exacerbation of chronic obstructive pulmonary disease/chronic bronchitis. In the diagnostic procedure, rapid tests of Streptococcus pyogenus and C-reactive protein may be valuable in carefully selected cases. Penicillins (penicillin V, amoxycillin) should be the first choice in most respiratory tract infections. Larger studies in general practice are needed to analyse the impact of antibiotic prescribing on morbidity, the occurrence of rare complications and spread of resistance. The greatest challenge will be to implement current knowledge in daily praxis.