The role of appropriate diagnostic testing in acute respiratory tract infections: An antibiotic stewardship strategy to minimise diagnostic uncertainty in primary care

South African guideline for the management of community-acquired pneumonia in adults

“…Without the benefit of CXR the diagnosis of CAP in outpatient settings is challenging and relies on clinical finding (6) and, if available, point-of-care (POC) biomarkers (32). A suggested way of diagnosing CAP in primary care when CXR is unavailable using clinical features and CRP has recently been presented (33). The accuracy of clinical criteria for diagnosing CAP is poor; a systematic review has shown that even combinations of symptoms and signs rarely increase the probability of the diagnosis by more than 50% (34).…”

Integrated Stewardship Model Comprising Antimicrobial, Infection Prevention, and Diagnostic Stewardship (AID Stewardship)

“…In summary, we are convinced that all three aspects in an integrated AID stewardship model are essential for optimal benefits. This integral view is also supported by a recent review on diagnostic stewardship (10) with the examples of acute respiratory tract infections (7) and quinolone resistance (8). Thus, we strongly advocate the implementation of integrated stewardship programs as a standard approach to optimize patient management and patient care, increase cost-effectiveness, and address the urgent problem of rising antimicrobial resistance (2,9).…”

Rational use of the fluoroquinolones

“…Conditions that should not be treated with a FQ (or any antibiotic) include viral infections, the common cold, influenza, acute bronchitis and pharyngotonsillitis (unless <16 years of age and streptococcus is suspected, and even in that case one can wait until results of a rapid test for group A streptococcus are available, and if antibiotics are indicated, a number of other more narrowspectrum antibiotics are as effective). [15] Travellers' diarrhoea Similarly, diarrhoea not associated with fever, bloody stools or other signs of systemic sepsis (i.e. those caused by shigella, campylobacter, Clostridium difficile, and protozoal infections) does not benefit from any antibiotic, including metronidazole, even in the immunocompromised host.…”