Acute respiratory tract infections are most often caused by viruses and do not require an antibiotic prescription, and yet they still account for 43 million office visits annually.

It is estimated that 60% of adults receive an antibiotic to treat a presumably viral acute respiratory tract infection. This leads to increased antibiotic resistance and costs the health care system between $20 billion and $55 billion dollars annually.

A few key symptoms can help patients and providers determine whether the illness is a bacterial or viral infection. 

Viral infections typically produce symptoms in many parts of the body with colorless phlegm. They typically do not cause a fever, and symptoms last a few days to a week.

Contrast that with bacterial infections, which generally stay in 1 area (throat, sinuses, or chest), produce green or yellow phlegm, are likely accompanied by a fever, and often last more than 10 days.

A recent study published in The American Journal of Managed Care looked at trends in antibiotic prescribing to see if recent extensive efforts to discourage antibiotic prescribing have worked.

The study examined patients seen by a physician with a diagnosis code of presumed viral acute respiratory tract infections. Of the 54,656 encounters studied, 49.4% filled an antibiotic prescription.  

Patients were more likely to be prescribed an antibiotic if they were seen in an urgent care facility or by a nurse practitioner or physician assistant.

A major point of concern was antibiotics prescribed for coughs labeled as “acute bronchitis.” Almost 70% of the patients received an antibiotic for treatment.

However, studies have shown that azithromycin, amoxicillin, and amoxicillin-clavulanate do not improve patient outcomes.

The study authors suggested telling patients that they have a “chest cold” (not acute bronchitis) and explaining why antibiotics will not be beneficial and that their symptoms may last for 2 weeks. 

The researchers also stated that antibiotics are not effective for acute bronchitis and other presumed viral acute respiratory tract infections.

There is a need for better validated clinical decision rules and tests to help determine viral versus bacterial infections, according to the study authors.