What criteria should I use to determine when to prescribe antibiotics for respiratory tract infections in adults?

Antibiotics for respiratory tract infections (RTIs) in adults should be prescribed based on a thorough clinical assessment considering the severity of symptoms, risk factors, and diagnostic support tools.

• Do not routinely prescribe antibiotics for acute respiratory infections (ARIs) unless there is clear clinical indication. Most ARIs are self-limiting and do not require immediate antibiotics ¹.
• Use clinical judgement and consider the patient's overall health, comorbidities, and social circumstances. The threshold for prescribing antibiotics is lower in people with comorbidities, multimorbidity, or frailty ¹.
• For lower respiratory tract infections (LRTIs) where the need for antibiotics is unclear, consider a point-of-care C-reactive protein (CRP) test: offer immediate antibiotics if CRP >100 mg/L; consider a back-up (delayed) prescription if CRP is between 20 and 100 mg/L; do not routinely offer antibiotics if CRP <20 mg/L ¹.
• If pneumonia is clinically suspected, use the CRB65 score to assess severity and guide management: consider hospital assessment for CRB65 ≥2; shared decision-making for CRB65 =1; home care for CRB65 =0 ¹.
• Do not rely on rapid point-of-care microbiological or influenza tests to decide on antibiotic prescribing. These tests are not recommended for guiding antimicrobial use in ARIs ¹.
• When antibiotics are considered, discuss with the patient the likely nature of the illness, benefits and harms of antibiotics, alternative options, and safety-netting advice. Document the reason for prescribing or not prescribing antibiotics and the care plan ².
• Do not issue immediate antibiotic prescriptions for likely self-limiting infections; consider back-up prescriptions or self-care advice instead. ²