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Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults: Background, Specific Aims, and Methods

Ralph Gonzales, MD, MSPH; John G. Bartlett, MD; Richard E. Besser, MD; Richelle J. Cooper, MD, MSHS; John M. Hickner, MD, MSc; Jerome R. Hoffman, MD, MA; and Merle A. Sande, MD
[+] Article and Author Information

From the University of Colorado Health Sciences Center, Denver, Colorado; Johns Hopkins University, Baltimore, Maryland; Centers for Disease Control and Prevention, Atlanta, Georgia; University of California, Los Angeles, Los Angeles, California; Michigan State University, East Lansing, Michigan; and University of Utah, Salt Lake City, Utah.


* After the primary author (Dr. Gonzales), authors are listed in alphabetical order.

In addition to the Centers for Disease Control and Prevention, the principles outlined in this document have been endorsed by the American Academy of Family Physicians, the American College of Physicians–American Society of Internal Medicine, and the Infectious Diseases Society of America.

Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.

Disclaimer: The Centers for Disease Control and Prevention sponsored the development of these principles and has approved all final products. As such, these documents do not necessarily reflect consensus of interpretation or opinion by all members of the Panel.

Acknowledgments: The authors thank reviewers from the Centers for Disease Control and Prevention, American College of Physicians–American Society of Internal Medicine Clinical Efficacy Analysis Subcommittee, American Academy of Family Practitioners, American College of Emergency Physicians, and Infectious Diseases Society of America for extensive and useful feedback. Experts in specific topic areas who provided feedback will be acknowledged in specific Principles articles. The authors also thank physicians who attended the annual session of the American College of Physicians–American Society of Internal Medicine (April 2000) and the clinicians from Kaiser Permanente, Colorado, for their comments.

Role of the Funding Sources: Partial support for the development of the Principles was provided by the Centers for Disease Control and Prevention, and final approval by the Centers for Disease Control and Prevention of all manuscripts submitted for publication was required. Dr. Cooper is supported in part by a National Research Service Award (F32 HS00134-1) from the Agency for Healthcare Research and Quality.

Requests for Single Reprints: Richard E. Besser, MD, Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, rbesser@cdc.gov.

Current Author Addresses: Dr. Gonzales: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262.

Dr. Bartlett: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 463A, Baltimore, MD 21287-0003.

Dr. Besser: Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.

Dr. Cooper: UCLA Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024.

Dr. Hickner: Department of Family Practice, Michigan State University, B-111 Clinical Center, East Lansing, MI 48824.

Dr. Hoffman: UCLA Emergency Medicine Center, 924 Westood Boulevard, Suite 300, Los Angeles, CA 90024.

Dr. Sande: Department of Medicine (4C104), University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132.


Ann Intern Med. 2001;134(6):479-486. doi:10.7326/0003-4819-134-6-200103200-00013
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The need to decrease excess antibiotic use in ambulatory practice has been fueled by the epidemic increase in antibiotic-resistant Streptococcus pneumoniae. The majority of antibiotics prescribed to adults in ambulatory practice in the United States are for acute sinusitis, acute pharyngitis, acute bronchitis, and nonspecific upper respiratory tract infections (including the common cold). For each of these conditions—especially colds, nonspecific upper respiratory tract infections, and acute bronchitis (for which routine antibiotic treatment is not recommended)—a large proportion of the antibiotics prescribed are unlikely to provide clinical benefit to patients. Because decreasing community use of antibiotics is an important strategy for combating the increase in community-acquired antibiotic-resistant infections, the Centers for Disease Control and Prevention convened a panel of physicians representing the disciplines of internal medicine, family medicine, emergency medicine, and infectious diseases to develop a series of “Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults.” These principles provide evidence-based recommendations for evaluation and treatment of adults with acute respiratory illnesses.

This paper describes the background and specific aims of and methods used to develop these principles. The goal of the principles is to provide clinicians with practical strategies for limiting antibiotic use to the patients who are most likely to benefit from it. These principles should be used in conjunction with effective patient educational campaigns and enhancements to the health care delivery system that facilitate nonantibiotic treatment of the conditions in question.

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