Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults

Publication Date: March 1, 2016
Last Updated: March 14, 2022

High-Value Care Advice

  • Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
  • Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
  • Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
  • linicians should not prescribe antibiotics for patients with the common cold.

Recommendation Grading




Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults

Authoring Organizations

Publication Month/Year

March 1, 2016

Last Updated Month/Year

June 1, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with acute respiratory tract infection

Target Patient Population

Patients with acute respiratory tract infection

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D001424 - Bacterial Infections, D012141 - Respiratory Tract Infections, D000073602 - Antimicrobial Stewardship


pneumonia, antibiotic, upper respiratory infection (URTI), infections, Antibiotic Stewardship, Antibiotic Resistance

Supplemental Methodology Resources

Data Supplement, Data Supplement