BrazJOtorhinolaryngol.2016;82(2):121---122
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
The
inappropriate
use
of
antibiotics
in
upper
respiratory
tract
infections:
it
is
time
for
action
夽
Uso
inadequado
de
antibióticos
em
infecc
¸ões
do
trato
respiratório
superior:
é
tempo
de
agir
Antibioticsareoneofthegreatestdiscoveries inmedicine and have significantly decreased mortality and morbidity ratesforinfectiousdiseasesduringthelast75years. How-ever,largequantitiesofantibioticsareutilizedempirically andinappropriately,particularlyforupperrespiratorytract infections.
The vast majority of these community-acquired infec-tions is initially caused by viruses, self-limited in their clinical evolution, and have no need of antibiotic treat-ment. A small percentage is complicated by secondary bacterial infection for which antibiotics could be useful. Several diverse factors can be responsible for this inap-propriate use of antibiotics. There is a lack of fast and accurate laboratory tests do differentiate bacterial from viral infections; patients sometimes believe that antibi-otics can relieve symptoms such as fever and pain and pressuredoctorstoprescribeantibioticswhentheir symp-tomsdonotimprovequicklywithothermedicaltreatment; doctorspracticedefensivemedicine,antibioticsare avail-ablewithout prescriptionsin many countries,anddoctors havedifficultyidentifyingpatientsathighriskofbacterial complications,suchastheelderly,immunocompromisedand carriersofchronicdiseases.
Brazilisthefourthlargestglobalconsumerofmedicines and40%oftheseareantibiotics.Since2011Brazilian phar-maciesarenotallowedtosellantibioticswithoutamedical prescriptionandsince2013allpharmacieshavetosubmit anelectroniccommunicationaboutantibioticsprescriptions totheANVISA(National Agencyfor Sanitary Vigilance). In thefirstyearaftertheimplementationofthispolicythere wasa 20% decrease in antibiotics prescriptions, but soon thereafter,thenumberincreasedagain.
夽
Pleasecitethisarticleas:PignatariACC,MyakeMM.The inap-propriateuseofantibioticsinupperrespiratorytractinfections:it istimeforaction.BrazJOtorhinolaryngol.2016;82:121---2.
Allergy,collateraleffectssuchasgastrointestinal symp-tomsandtoxicity(hepatic,renal, neurologic,cardiacand teratogenicity) are well described, and can occur with drug usage from the majority of the antibiotics classes. Resistance to antibiotics, sometimes with multiresistant bacteria,is usuallyseen innosocomial infections butalso occursincommunityinfections.
Currentlytherearefewnewavailableclassesof antibi-otics, and it is very important topreserve the commonly usedantibioticsparticularly theclassof B-lactamsthat is characterized by low toxicity in the majority of patients including neonates, children, pregnant woman and the elderly.Whentheyareindicatedthebasiccriteriafor antibi-oticusageshouldbereinforcedconstantlyinthetreatment basedoninternationalandlocalguidelinesfor each cate-goryofinfection.Collateraleffectsandtoxicityarerelevant forthepatientasan individualbutbacterial resistanceis relevantfortheentirecommunity.
Anotherimportantrecenttopicisthelong-termeffects of antibiotics onthe human microbiome that may persist throughout an entire life span and is probablyassociated withchronicinflammatorydiseasesandeventosometypes ofneoplasia.
All these issues are important and are addressed globally by different institutions and scientific societies, governments, ONGs and private organizations promoting the rational use of antibiotics. Doctors, pharmacists and patientsareco-responsibleforthesuccessofthisendeavor and otorhinolaryngologists must be fully involved. More effortsineducation,trainingandresearcharewarranted, but the effort of each individual is essential at this moment.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
http://dx.doi.org/10.1016/j.bjorl.2015.12.003
122 EDITORIAL
Recommended
reading
EssakS,PignatariAC.Aframeworkforthenon-antibiotic manage-mentof upper respiratory tract infections: towards a global changein antibiotic resistance.IntJ ClinPract Suppl.2013; 180:4---9.
VanderVeldenA,DuerdenMG,BellJ,OxfordJS,AltinerA,Kozlov R,etal.Prescribersandpatients’responsibilitiesintreatment ofacuterespiratorytractinfections---essentialforconservation ofantibiotics.Antibiotics.2013;2:316---27.
WorldHealth Organization. Theevolving threat of antimicrobial resistance---optionsforaction;2012http://whqlibdoc.who.int/ publications/2012/978024
National Institute for Health and Clinical Excellence (NICE). Clinicalguideline69.Respiratorytractinfections--- antibiotic
prescribing.Prescribingofantibioticsfor self-limiting respira-torytractinfectionsandinadultsandchildreninprimarycare; 2008http://www.nice.org.uk/cg069
AntonioCarlosCamposPignataria,∗, MonicaMenonMyakeb
aDisciplineofInfectiousDiseases,UniversidadeFederalde
SãoPaulo(UNIFESP),SãoPaulo,SP,Brazil bNúcleodeOtorrinolaringologiadoHospitalSírioLibanês,
SãoPaulo,SP,Brazil
∗Correspondingauthor.
