Chapter 6: Respiratory Tract Infection

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Indications for antibiotic therapy in URTI

Persistent symptoms of acute rhinosinusitis lasting for ≥ 10 days without clinical improvement;

• Severe symptoms or signs including high fever, purulent nasal drainage or facial pain lasting for at least 3 –4 consecutive days at the beginning of the illness;
• Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection (URI) that lasted 5–6 days and were initially improving (“double-sickening”).

Patient Risk Stratification

Patient Type 1 (CAI):

• Patient No contact with health care system
• No prior antibiotic treatment in last 90 days
• Patient young with no co-morbid conditions

Type 2 (HCAI): 

• Recent contact with health care system (e.g. recent hospital admission, nursing home, CAPD) without/minimal invasive procedures
• Antibiotic therapy in last 90 days
• Patient old (> 65 years) with few co-morbidities