Practice pointer for the COVID-19 pandemic: caution urged in antibiotic prescribing for respiratory infections

• Virtual assessments during the COVID-19 pandemic have limited diagnostic capabilities and lead to antibiotic overprescribing for RTIs.
• Judicious prescribing is recommended and in-person assessment for suspected bacterial RTIs should follow virtual consultations.
• Provide diagnostic clarity, address patient concerns, offer a symptom management plan, and ensure that a safety net or contingency plan is in place.

Key points

• Most RTIs are self-limiting.
• Avoid antibiotics for suspected viral RTIs (COVID-19, influenza, influenza-like-illness).
• Schedule in-person follow-up should the following occur:
  • Acute otitis media: symptoms >48 hours, fever ≥39°C.
  • Pharyngitis: worsening/persistent symptoms >48 hours, high suspicion of bacterial pharyngitis.
  • Sinusitis: no improvement >7 days, presence of red flags (e.g., headache, altered mental status, ophthalmic symptoms such as orbital swelling or double vision, neurologic deficits).
  • COPD: with shortness of breath that prevents activities of daily living.
  • Suspected pneumonia: in-person visit required.
  • Common cold: dehydration, red flags.

Study design

• Practice pointer based on Medline, Cochrane randomized controlled trials, meta-analyses to summarize the best evidence supporting a standardized approach to antibiotic prescribing for RTIs in the era of COVID-19.
• Funding: None disclosed.

Limitations

• Selection bias.
• Inconsistent methods across studies.