Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study

Bel Haj Ali, Khaoula; Sekma, Adel; Messous, Selma; Trabelsi, Imen; Ben Youssef, Jalel; Maghraoui, Hamida; Razgallah, Rabie; walha, Adel; Grissa, Mohamed Habib; Beltaief, Kaouthar; Mezgar, Zied; Coubantini, Ahmed; Bouida, Wahid; Msolli, Mohamed Amine; Boukef, Riadh; Boubaker, Hamdi; Nouira, Semir

doi:10.1186/s12875-022-01904-7

Table 2 First choice antibiotics for RTIs according to local recommendations compiled from national and international guidelines

From: Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study

Pathologies	First choice antibiotic	Doses	Duration of treatment	Comments
Nasopharyngitis and tonsillitis	First choice For individuals without penicillin allergy			Prescribe antipyretics and analgesics.-Lactam antibiotics are indicated according to FeverPAIN and/or Centor score
	Penicillin V, oral	500 mg 4 times daily or 1000 mg twice daily	5 to 7 days
	Amoxicillin, oral	500 mg twice Daily	5 to 7 days
	Benzathine penicillin G, intramuscular	1 200 000 U	1 dose
	Alternative first choice for penicillin allergy or intolerance
	Clarithromycin, oral	250 mg twice daily	5 to 7 days
	Azithromycin, oral	500 mg once daily	3 days
Acute bronchitis	Never indicated	-	-	In the absence of pneumonia, antibiotics are not indicated. Routine testing for nonviral causes is not recommended
Sinusitis	First choice			Acetaminophen or ibuprofen can relieve pain and fever. Saline irrigations, or washing out the nose with salt water, can relieve symptoms and remove mucus that is hard to blow out. Nasal steroid sprays can reduce symptoms after 15 days of use. Antibiotics may be prescribed if symptoms last > 10 d, severe symptoms last for > 3 consecutive days, or worsening symptoms last after 3 consecutive days
	Penicillin V, oral	500 mg 4 times daily	5 days
	Amoxicillin-clavulanate, oral	500/125 mg 3 times a day	5 to 7 days
	Alternative first choices for penicillin allergy or intolerance
	Doxycycline, oral	200 mg on first day, then 100 mg once a day	5 days
	Clarithromycin, oral	500 mg twice daily	5 days
Otitis media	First choice			Offer regular doses of paracetamol or ibuprofen for pain. Consider eardrops containing an anaesthetic and an analgesic for pain if an immediate antibiotic is not given, and there is no eardrum perforation or otorrhoea
	Amoxicillin, oral	500 mg three times a day	5 to 7 days
	Amoxicillin-clavulanate, oral	500/125 mg 3 times a day	5 to 7 days
	Alternative first choice for penicillin allergy or intolerance
	Clarithromycin, oral	500 mg twice daily	5 to 7 days
	Cefuroxime, oral	(30 mg/kg) per day in 2 divided doses	5 to 7 days
Acute COPD exacerbation	First choice			Indication for antibiotic treatment of acute exacerbations of COPD - Severe or very severe COPD with purulent sputum - Mild and moderate COPD with purulent sputum and inflammatory syndrome (CRP > 40 mg/dl) - Mild and moderate COPD with purulent sputum that does not improve after 3 days of treatment with bronchodilator and physiotherapy
	Amoxicillin, oral	500 mg three times a day	5 to 7 days
	Doxycycline	200 mg on first day, then 100 mg once a day	5 to 7 days
	Azithromycin, oral	500 mg once daily	3 days
	Clarithromycin	500 mg twice a day	5 to 7 days

Abbreviations: ARTIs Acute respiratory tract infections, COPD Chronic obstructive pulmonary disease

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ISSN: 2731-4553

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