Treating the immunocompetent patient who presents with an upper respiratory infection: Pharyngitis, sinusitis, and bronchitis

Infections of the upper respiratory tract are among the most common conditions seen in primary care [1]. The upper respiratory tract consists of the oropharynx, nares, and nasopharynx, which are lined by stratified squamous epithelium; and the sinuses, larynx, and trachea, areas generally lined by columnar, goblet, and gland cells. There are normal flora occupying the former, and the evaluation of infections is complicated by the presence of colonizing species, which may have no role in infection. The latter group is generally sterile, and requires invasive measures to access and obtain material for culture [2]. Physiological mucous production may be altered here by nonspecific and noninfectious causes, further complicating diagnosis. Because the specific etiological agent of an upper respiratory infection (URI) is often not identified, clinical judgment. is required in the approach to their diagnosis and treatment. The causative agent of these infections is typically a virus, yet studies have reported rates for antibiotic prescriptions of 46% for pediatric patients [3] and of 52% for adults [4]. In this article, the author reviews the evidence-based approach to treatment of the immunocompetent patient who has URI, with a focus on the rational use of antibiotics in treating pharyngitis, sinusitis, and bronchitis.