PRACTICE PARTNER
Key Practice Changes for Upper Respiratory Tract
Infections in Primary Care Setting
Uncomplicated otitis media
DON’T prescribe antibiotics in vaccinated chil-
dren more than six months old and adults in
whom you suspect acute otitis media, unless
there is either a perforated tympanic mem-
brane with purulent discharge or a bulging
tympanic membrane with one of the three
following criteria:
1. Fever (≥39°C).
2. Moderately or severely ill.
3. Significant symptoms lasting > 48 hours.
Uncomplicated pharyngitis
routinely prescribe antibiotics unless
the patient’s modified Centor score is ≥ 2
AND throat swab culture (or rapid antigen
test if available) confirms presence of Group
A Streptococcus.
DON’T
perform throat swabs at all for patients
with Centor score ≤ 1, OR if there are symp-
toms of a viral infection such as rhinorrhea,
oral ulcers or hoarseness.
DON’T
Uncomplicated sinusitis
DON’T prescribe antibiotics unless symptoms
have persisted for greater than 7-10 days
without improvement.
Differentiating viral rhinosinusitis (VRS)
from acute bacterial rhinosinusitis (ABRS)
can be challenging. Patients not meeting the
below criteria are best managed with a viral
prescription. Antibiotics should only be con-
sidered if the patient has at least two of the
below PODS symptoms, one of those being
O or D, AND the patient meets one of the
following criteria:
1. The symptoms are severe.
2. The symptoms are mild to moderate symp-
toms if there is no response after a 72 hours
trial with nasal corticosteroids.
P: Facial Pain/pressure/fullness;
O: Nasal Obstruction;
D: Purulent/discolored nasal or postnasal
Discharge;
S: Hyposmia/anosmia (Smell)
Pneumonia
prescribe antibiotics for pneumonia
unless there is objective evidence.
If access to a chest x-ray is available near
your clinic, don’t routinely prescribe antibiot-
ics for suspected pneumonia without con-
firming the presence of a new consolidation.
Physical examination alone, demonstrat-
ing respiratory crackles, is not sufficient to
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DIALOGUE ISSUE 4, 2018
DON’T