Rational prescribing for upper respiratory tract infections (URTI)

Abstract

Upper respiratory tract infections (URTI) are the most common illnesses encountered in family medicine. Prescribing for this condition has a great health and economic impact. This paper critically appraises the rationale behind the prescribing of different drugs for URTI. Over 90% of URTI are self-limiting and are caused by viruses that do not require any curative treatment. Research data show that curative treatment is available for only the very small proportion of URTI that are caused by influenza viruses or bacteria, and the benefit is modest. Many drugs advocated for the relief of URTI symptoms lack support from research evidence. There is no justification for the use of steroids or non-steroidal anti-inflammatory drugs (NSAID) because their benefits are doubtful and their side effects can be serious. Apart from influenza vaccine for the prevention of influenza, no drug has been fully proven to be effective in preventing URTI or its complications. Local studies have shown that not all patients expect a pill for every ill and some patients think the doctor gives too many drugs. A careful analysis of the nature and severity of the patient's symptoms can lead to the rational prescribing of the least number of the most needed drugs.