Acute Upper Respiratory Tract Infection
This guideline aims to assist healthcare workers with antibiotic prescribing for common clinical syndromes in adult patients in South Africa, utilizing Local and International guidelines, key publications, and expert opinion.
Acute pharyngotonsillitis (sore throat)
Acute otitis media
Acute bacterial sinusitis
Over-prescribing of antibiotics for upper respiratory tract infection (URTI) is a major driver of bacterial resistance in the community. URTI comprises three clinical syndromes depending on the site of infection; pharyngotonsillitis (sore throat), acute otitis media, and acute bacterial sinusitis.
ACUTE PHARYNGOTONSILITIS (sore throat)
Typical appearance of viral pharyngitis
Typical appearance of bacterial pharyngitis
Definition
- Acute inflammation of the pharyngeal wall and tonsils.
Likely pathogens
- Commonly respiratory viruses and Epstein-Barr virus. Around 5‐30% caused by group A βhaemolytic streptococci (GABHS) (S. pyogenes).
- Viral and bacterial acute pharyngitis are self‐limiting, including those caused by GABHS, hence, the primary reason for considering antibiotic therapy is to prevent Acute Rheumatic Fever (ARF)
Clinical features
- Sore throat
- It is possible to differentiate bacterial from viral causes on clinical grounds.
Penicillin allergy
Azithromycin 500 mg po daily for 3 days
ACUTE OTITIS MEDIA
Typical appearance of acute otitis media
Definition
- Acute inflammation of the middle ear
Likely pathogens
- Haemophilus influenza, Streptococcus pneumoniae, Moraxella catarrhalis
Clinical features
- Ear pain and decreased hearing
- Reddened and bulging tympanic membrane, which may be draining pus.
Tests
- None required
Treatments
- Initially analgesics and decongestants only
- Antibiotics if febrile or symptoms do not settle within 48 hrs
First line
Amoxicillin 1g po 8‐hourly for 5 days
Alternative in beta-lactam allergic patients
Azithromycin 500 mg po daily for 3 days
ACUTE BACTERIAL SINUSITIS
Definition
- Acute bacterial infection of para-‐nasal sinuses
Likely pathogens
- Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis
Clinical features
- Often preceded by a viral URTI
- Fever, facial tenderness, dental tenderness, nasal discharge, nasal congestion and anosmia.
Tests
- Usually none
- If failure of initial therapy a CT scan, fibre-optic endoscopy with aspiration and culture of pus may be necessary
Treatments
- Symptomatic treatment: paracetamol, decongestant, nasal steroids perform better than antibiotics
- Antibiotics should be prescribed if any of the following are present:
- Symptoms lasting > 10 days
- Fever >39°C
- Purulent discharge
- Facial pain
- Biphasic illness with sinusitis following typical viral URTI
First line
Amoxicillin 1g 8 hourly for 5 days po
Alternative for beta-lactam allergy
Azithromycin 500 mg po daily for 3 days