- The clinician-led "Choosing Wisely" campaign, present in 20 countries, discourages antibiotic prescribing for upper respiratory tract infections (RTIs) in patients presenting with signs/symptoms indicative of mild, self-limiting COVID-19.
Why this matters
- 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.
- 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.
- 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.
- Selection bias.
- Inconsistent methods across studies.