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.