A framework for the non-antibiotic management of upper respiratory tract infections
OR I G I NAL PAPER A framework for the non-antibiotic management of upper respiratory tract infections: towards a global change in antibiotic resistance S. Essack, 1 A. C. Pignatari 2, * SUMMARY Antibiotic resistance has become a critical health issue on a global scale, with much of the problem resulting from inappropriate use of antibiotics in primary care. To change this practice, the global respiratory infection partnership has for- mulated a pentagonal (five P) framework for the non-antibiotic management of upper respiratory tract infections (URTIs) – one of the most common conditions in primary care for which antibiotics are prescribed. The framework presents the rationale for focusing on URTIs to promote antibiotic stewardship in primary care and elaborates on five key areas to focus on to bring about change: policy, pre- vention, prescribers, pharmacy and patients. The ultimate aim is to adopt a patient-centred symptomatic management strategy using a flexible framework that can be adapted across countries to create a consistent global approach to change behaviour. What’s new • Innovative framework targeting key role players to elicit a change in behaviour to address rising resistance rates in the community What’s known • Antibiotic resistance is an escalating global health threat largely attributable to indiscriminate antibiotic use, especially in community settings Introduction Antibiotic resistance is a critical health issue on a global scale (1,2). Much of the problem results from the inappropriate use of antibiotics, in particular their overuse, in primary care. The containment of antibiotic resistance requires a consistent and coordi- nated approach towards symptomatic treatment in applicable primary care conditions where inappropri- ate antibiotic use is a problem. The most common reason for patients to seek medical attention in primary care is infection of the upper respiratory tract, such as sore throat, common cold, influenza, earache and cough (3). These infec- tions also account for a large proportion of the anti- biotics prescribed in primary care (Figure 1) (4). Depending on the country, 34 – 60% of patients with an upper respiratory tract infection (URTI) receive an antibiotic (5). Yet, the majority of these patients do not require an antibiotic because most URTIs are of viral origin and are self-limiting, complications are rare and an array of non-antibiotic treatment options are available to provide symptomatic relief (5). To facilitate a change towards prudent use of antibi- otics for the treatment of URTIs, members of the Glo- bal Respiratory Infection Partnership (GRIP) have developed a framework for the non-antibiotic man- agement of such infections. The framework presents the rationale for focusing on URTIs to promote anti- biotic stewardship in primary care and elaborates on five key areas to focus on to bring about change: pol- icy, prevention, prescribers, pharmacy and patients. This framework has been shared with and reviewed by healthcare professionals from Australia, Austria, Brazil, Germany, Hungary, India, Ireland, Israel, Italy, The Netherlands, Romania, Russia, Singapore, South Africa, Spain, Thailand, the United Kingdom and the United States of America. The global frame- work is strengthened through a collaborative approach by multiple primary healthcare provider specialties and is applicable across countries and conti- nents (Figure 2). It is envisaged as a prototype that can be adapted to other infections in the long term (5). Policy An environment that nurtures change enables its sus- tainability (6). In the context of appropriate, rational antibiotic use for URTIs, this means creating a policy environment where antibiotic use is not the norm. At present, there is wide variation between coun- tries in how antibiotics are used in primary care. In some countries, patients can self-treat with antibiot- ics by buying them over the counter, whereas in other countries antibiotics are only available on prescription. Treatment guidelines and essential 4 ª 2013 John Wiley & Sons Ltd Int J Clin Pract , November 2013, 67 (Suppl. 180), 4–9 doi: 10.1111/ijcp.12335 1 School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 2 Escola Paulista de Medicina- Universidade Federal de S ~ ao Paulo, Rua Leandro Dupret 188, Sao Paulo, Brazil Correspondence to: Sabiha Essack, School of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa Tel.: +2731 2608048 Fax: +2731 2607872 Email: firstname.lastname@example.org * In collaboration with the Global Respiratory Infection Partnership: Attila Altiner (Germany), John Bell (Australia), Martin Duerden (UK), Sabiha Essack (South Africa), Roman Kozlov (Russia), John Oxford (UK), Antonio Carlos Pignatari (Brazil), Aurelio Sessa (Italy), Alike van der Velden (The Netherlands).