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Feature Article

Oral antibiotics: optimal prescribing in the community

Adrienne Torda

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Abstract

Recently, there have been several additions to the oral antimicrobial options for common infections, and it is often difficult to know when to use the newer antibiotics. This article discusses the optimal use of both the newer and the more classical oral antibiotics.

Key Points

  • Most community acquired upper respiratory infections are viral and will not respond to antibiotics.
  • Bacterial infections may complicate primary viral infections (especially in the upper respiratory tract) but do so in a minority of cases.
  • Patient education is very important in avoiding the overuse of antibiotics.
  • Be familiar with local bacterial resistance patterns.
  • When empirically treating an infection, start with as specific an antibiotic as is reasonable. Reassess and change if there is no clinical response by about 48 hours.
  • If there are factors that make the consequences of ineffective treatment catastrophic (e.g. immunocompromise, CNS involvement, newborn), it may be wise to seek specialist advice initially.
  • The newer oral antibiotics increase the repertoire from which we can choose; they don’t necessarily have huge advantages over the more classical oral antibiotics.

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