Forum

Updated recommendations for the management of upper respiratory tract infections in South Africa

Adrian J Brink, Mark F Cotton, Charles Feldman, Heather Finlayson, Ray L Friedman, Robin Green, Willy Hendson, Maurice H Hockman, Gary Maartens, Shabir A Madhi, Gary Reubenson, Eddie J Silverbauer, Inge L Zietsman

Abstract


Background. Inappropriate use of antibiotics for non-severe upper respiratory tract infections (URTIs), most of which are viral, significantly adds to the burden of antibiotic resistance. Since the introduction of pneumococcal conjugate vaccines in South Africa in 2009, the relative frequency of the major bacterial pathogens causing acute otitis media (AOM) and acute bacterial rhinosinusitis (ABRS) has changed.

Recommendations. Since URTIs are mostly viral in aetiology and bacterial AOM and ABRS frequently resolve spontaneously, these recommendations include diagnostic criteria to assist in separating viral from bacterial causes and hence select those patients who do not require antibiotics. Penicillin remains the drug of choice for tonsillopharyngitis and amoxicillin the drug of choice for both AOM and ABRS. A dose of 90 mg/kg/d is recommended for children, which should be effective for pneumococci with high-level penicillin resistance and will also cover most infections with Haemophilus influenzae. Amoxicillin-clavulanate (in high-dose amoxicillin formulations available for both children and adults) should be considered the initial treatment of choice in patients with recent antibiotic therapy with amoxicillin (previous 30 days) and with resistant H. influenzae infections pending the results of studies of local epidemiology (β-lactamase production ≥15%). The macrolide/azalide class of antibiotics is not recommended routinely for URTIs and is reserved for β-lactam-allergic patients.

Conclusion. These recommendations should facilitate rational antibiotic prescribing for URTIs as a component of antibiotic stewardship. They will require updating when new information becomes available, particularly from randomised controlled trials and surveillance studies of local aetiology and antibiotic susceptibility patterns. 


Authors' affiliations

Adrian J Brink, Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa

Mark F Cotton, Division of Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children’s Hospital, Cape Town, South Africa

Charles Feldman, Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Heather Finlayson, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children’s Hospital, Cape Town, South Africa

Ray L Friedman, Mediclinic Sandton and Netcare Linksfield Clinic, Johannesburg, South Africa

Robin Green, Department of Paediatrics and Child Health, University of Pretoria, South Africa

Willy Hendson, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Maurice H Hockman, Netcare Linksfield Hospital, Johannesburg, South Africa

Gary Maartens, Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa

Shabir A Madhi, National Institute for Communicable Diseases and Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Gary Reubenson, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand and Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa

Eddie J Silverbauer, Ampath National Laboratory Services, Sunninghill and Waterfall hospitals, Johannesburg, South Africa

Inge L Zietsman, Ampath National Laboratory Services, Sandton, Johannesburg, South Africa; Morningside Clinic, Johannesburg, South Africa

Full Text

PDF (167KB)

Keywords

Management; Antibiotics; Inappropriate use; Upper respiratory tract infections; South Africa

Cite this article

South African Medical Journal 2015;105(5):345-352. DOI:10.7196/SAMJ.8716

Article History

Date submitted: 2015-09-17
Date published: 2015-09-17

Article Views

Abstract views: 4041
Full text views: 2333

Comments on this article

*Read our policy for posting comments here