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Antibiotic Prescribing for Nonbacterial Acute Upper Respiratory Infections in Elderly Persons

TO THE EDITOR: Acute nasopharyngitis, acute sinusitis, acute laryngitis/tracheitis, and acute bronchitis can be caused by viruses, but they can also be caused by bacteria. Silverman and colleagues' (1) attempts to exclude bacterial infections are inappropriate. These infections are not microbiologically confirmed (except perhaps for pharyngitis, but whether the authors considered rapid testing for group A Streptococcus is unclear). One Cochrane review shows benefit for antibiotic treatment of sinusitis, and another shows modest benefit for antibiotics for acute bronchitis (2, 3). Silverman and colleagues did not attempt to exclude streptococcal pharyngitis. Acute nasopharyngitis is not the common cold. I am all in favor of reducing unnecessary antibiotic use and studying how to achieve this goal. However, the term nonbacterial in the title and elsewhere is inappropriate. Analyzing who prescribed antibiotics for these conditions is interesting, but these infections cannot be called nonbacterial. This factor should have been stated as a limitation (in the abstract) at a minimum, but refraining from the designation of nonbacterial would have been more appropriate.