Толковый совет от CDC. Коллеги опубликовали его в январе, но у нас руки не доходили. Это поучительно
не только потому, что в США не рекомендуют ингавирина, но и потому, что видно, насколько разная ПРАКТИКА. Полный текст доступен бесплатно. Ниже — реферат на англ.
В основе, конечно, то, что при простуде (ОРВИ по-нашему) АБ назначать не надо.
Если не предполагается пневмония, то при бронхите не только не назначать, но и не проводить тесты.
Тестировать только при подозрении на стрептококковый фарингит быстрым тестом или на культуру. АБ — только при положительном результате.
При остром гайморите АБ только больным более 10 дней, лихорадке, лицевой болью и гнойными выделениями 3+ дней, или при ухудшении после временного улучшения после типичного течения ОРВИ.
Background: Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.
Methods: A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: “acute bronchitis,” “respiratory tract infection,” “pharyngitis,” “rhinosinusitis,” and “the common cold.”
High-Value Care Advice 1: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
High-Value Care Advice 2: 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.
High-Value Care Advice 3: 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).
High-Value Care Advice 4: Clinicians should not prescribe antibiotics for patients with the common cold.
