Most acute respiratory tract infections (RTIs) are viral and can be managed through virtual care
For patients with RTI symptoms who test negative for covid-19, a diagnosis of viral RTI remains most likely, and supportive management can continue to be offered virtually in most cases
Virtual assessments limit diagnostic capabilities and can lead to overprescribing of unnecessary antibiotics. For those RTIs that may be bacterial, arrange an in-person assessment where possible to confirm the diagnosis (eg, to assess the tympanic membrane, to perform a test for Group A streptococcus, or to obtain a chest radiograph).
Unnecessary prescriptions of antibiotic medication result in preventable adverse drug reactions and are driving antimicrobial resistance—an international public health threat. Nearly half of all outpatient antibiotics are intended to treat respiratory tract infection (RTI), even though one third to half of these are inappropriately prescribed for patients without a bacterial respiratory infection.
Before the covid-19 pandemic, international efforts such as the Choosing Wisely campaigns had focused on advancing improved antibiotic prescribing practices for the management of RTI. In the era of covid-19, primary care delivery has been disrupted, and many clinicians have shifted to virtual care whenever possible, especially when supplies of personal protective equipment are limited. Clinicians who provide primary care are faced with challenging questions in the management of RTI, including when a patient should be tested for SARS-CoV-2, the virus that causes covid-19, when to prescribe antibiotics, and when a patient should be assessed in person. More than ever, a standardised approach is needed that is informed by best available evidence and promotes the judicious use of antibiotics for RTI.
