Introduction
For health care professionals, in order to address uncertainties that may appear in clinical practice, it is essential to ask relevant clinical questions. Answers to them frequently provide guidance on the most appropriate ways of health care delivery with regard to patients’ needs. The most common format of guidelines for evidence-based practice uses the acronyms PIO, PICO, PICOS, or PICOT (Polit & Beck, 2018). In them, P stands for patients or population, I is an intervention or influence, C is comparison, O means outcomes of the intervention, S is for settings, and T refers to time. In order to answer these questions, researchers should search for evidence clinical practice guidelines, systematic reviews, and other preprocessed reliable sources.
Rationale of the Study
The topic chosen for research is the efficiency and rationale of antibiotic treatment for patients with upper respiratory infections as there are specific concerns in this area. On the one hand, upper respiratory infections may be regarded as a common health disorder, however, if left untreated, it may lead to severe complications, especially in older adults, infants, and people with pre-existing immune system disorders. In this case, appropriate treatment, including antibiotics therapy, is necessary. At the same time, there are multiple studies that indicate inappropriate use of antibiotics for the treatment of upper respiratory infections that may lead to antibiotic resistance in the future. The seriousness of this issue is determined by the fact that due to antibiotic resistance, the treatment of particular infectious diseases becomes less effective.
PICOT Question
Thus, in order to examine the rationale of antibiotics’ use for the treatment of upper respiratory infection, it is necessary to form a PICOT question on a first-priority basis. It will be the following: In patients with upper respiratory infections, does antibiotic treatment for 10 days clear infection faster than if patients had no antibiotics? where P means patients with upper respiratory infections, I – antibiotics treatment, C – absence of antibiotic treatment, O – faster improved state without infection, and T – the period of 10 days. Evidence will be detected in reliable peer-reviewed articles and clinical guidelines that will be searched in databases, including Medline, CINAHL, PubMed, and Google Scholar on the basis of keywords related to this topic (“upper respiratory infection,” “antibiotics,” “antibiotic resistance”).
Literature Review: Results
According to the results of the literature review, the expediency of antibiotics’ use for the treatment of upper respiratory infections is determined by their type. According to Yoon et al. (2017), upper respiratory infections may be both bacterial and viral. Respiratory viruses include adenovirus, influenza virus, rhinovirus, parainfluenza virus, echovirus, coxsackievirus, coronavirus, metapneumovirus, and respiratory syncytial virus (Yoon et al., 2017). When upper respiratory infection is caused by a virus, the use of antibiotics that aim to affect bacteria will be inefficient and may cause complications, including antibiotic resistance. In the case of infection caused by a respiratory virus, symptomatic treatment may be applied for the first 10 days.
Antibiotics treatment is necessary for patients with acute pharyngotonsillitis caused by bacteria especially when they have comorbidities or other complications (Yoon et al., 2017). Additional factors that presuppose the use of antibiotics include the duration of illness (more than 10 days), age (infants younger than 6 months old), and the severity of symptoms that may indicate the affection of other organs (Plitcher et al., 2018).
At the same time, there is multiple research that indicates the significance of appropriate use of antibiotics treatment as inappropriate use may lead to antibiotic resistance. According to Chokshi et al. (2019), fundamental causes of antibiotic resistance in developing nations include the lack of resistant development surveillance, clinical misuse, poor quality of antibiotics, and the high availability of this kind of medication. For developed countries, the major contributors to an increasing antibiotic resistance are excessive use of antibiotics in farming and a low level of control over antibiotic use in healthcare facilities (Chokshi et al., 2019). The evidence of the inappropriate use of antibiotics is supported by the study of Pulia et al. (2018) who state that inappropriate antibiotic use was identified in almost 81% of outpatient clinic prescriptions, 73.3% of emergency department initiations, and nearly 56% of NH prescriptions.
All authors emphasize the significance of this issue as antibiotic resistance is developing faster than before. In this case, some researchers aim to examine the ways of treatment for patients with existing antibiotic resistance. For instance, according to Durdu et al. (2019), a combination of tigecycline and trimethoprim-sulfamethoxazole may be regarded as an efficient therapy for patients with resistance.
Conclusion
Answering the PICOT question, it is possible to conclude that it requires particular improvement to provide a reliable answer. In patients with upper respiratory infections, it is necessary to identify an infectious agent first. In the case of viruses, antibiotic treatment is not necessary and inefficient – with symptomatic treatment, infection will clear within 10 days. However, when infections are caused by bacteria, a patient is younger than 6 months old or has complications or long-lasting symptoms, antibiotic treatment is essential regardless of the time. These precautions are determined by growing antibiotic resistance due to inappropriate antibiotic treatment, especially when it was not required.
References
Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global contributors to antibiotic resistance. Journal of Global Infectious Diseases, 11(1), 36-42. Web.
Durdu, B., Meric Koc, M., Hakyemez, I. N., Akkoyunlu, Y., Daskaya, H., Sumbul Gultepe, B., & Aslan, T. (2019). Risk factors affecting patterns of antibiotic resistance and treatment efficacy in extreme drug resistance in intensive care unit-acquired Klebsiella Pneumoniae infections: A 5-year analysis. Medical Science Monitor, 25, 174-183. Web.
Piltcher, O. B., Kosugi, E. M., Sakano, E., Mion, O., Testa, J. R. G., Romano, F. R.,… & Tamashiro, E. (2018). How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel. Brazilian Journal of Otorhinolaryngology, 84, 265-279.
Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Wolters Kluwer.
Pulia, M., Kern, M., Schwei, R., Shah, M., Sampene, E., & Crnich, C. (2018). Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis. Antimicrobial Resistance & Infection Control, 7(1), 1-8. Web.
Yoon, Y. K., Park, C. S., Kim, J. W., Hwang, K., Lee, S. Y., Kim, T. H.,… & Kim, S. W. (2017). Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Infection & Chemotherapy, 49(4), 326-352. Web.