Table 1.

Recommendations about the prescribing of antibiotics for the guidelines acute cough, acute rhinosinusitis, and urinary tract infections

Guideline	Acute cough, last version 201349	Acute rhinosinusitis, last version 201450	Urinary tract infections, last version 201351
Diagnoses (ICPC)	Acute cough (R05), Whooping cough (R71), Laryngitis/tracheitis acute (R77), Acute bronchitis/bronchiolitis (R78)	Sinus symptom/complaint (R09), Upper respiratory infection acute (R74), Sinusitis acute/chronic (R75)	Dysuria/painful urination (U01), Urinary frequency/urgency (U02), Cystitis/urinary tract infection (U71)
Antibiotics recommendations in guideline	No antibiotics if pneumonia is not considered likely. Exceptions in which antibiotics should be considered are patients with one or more risk factors: • Age <3 months or >75 years • Relevant comorbidity: heart failure, severe COPD, diabetes mellitus (in particular when using insulin), neurological diseases, severe kidney diseases • Poor immune response CRP in adults: <20 mg/L no indication for antibiotics, 20–100 mg/L indication for antibiotics depends on the clinical presentation, >100 mg/L indication for antibiotics	In principle, no antibiotics. Antibiotics are indicated in patients who are seriously ill. Antibiotics can be considered in patients with poor immune response: • Chronic use of corticosteroids or other immunosuppressive medicines • HIV infection with a reduced number of T-cells • Chemotherapy or radiotherapy • Immune disorders • Frail elderly who are sick • Patients with diabetes mellitus Antibiotics can be considered for patients who have had fever for more than 5 days, or for patients who have recurrent fever after a few fever-free days within one episode of rhinosinusitis	• Healthy women aged 12 years and older who are not pregnant: the GP […] discusses the possibility of wait and see […] and a postponed antibiotics prescription • Recurrent cystitis in healthy women (12 years and older) who are not pregnant: […] (three or more yearly) the following options: self-treatment with a postponed antibiotics prescription, or prophylactic treatment with […] continuous antibiotic prophylaxis • Cystitis in risk groups: patients in risk groups have an increased risk for complications of cystitis. In those patients, cystitis should be treated with antibiotics, in anticipation of the test results. Risk groups include: pregnant women, men, patients with diabetes mellitus, patients with poor immune response, and patients with abnormalities of the kidneys or urinary tract • Urinary tract infection with signs of tissue invasion: explain […] that antibiotic treatment is necessary […]
Antibiotics not indicated…	In patients with cough (R05, R77, R78) between 18 and 75 years, without indications for poor immune response,a with CRP <20 and without relevant comorbidity	In patients with sinus complaints (R09, R74, R75) without indications for poor immune response	In patients with urinary complaints (U01, U02)
Antibiotics can be considered…	In patients with cough (R05, R77, R78) over 75 years, or with indications for poor immune response, or with CRP >20 or with relevant comorbidity and in patients with whooping cough (R71)	In patients with sinus complaints (R09, R74, R75) with an indication for poor immune response	In healthy women, who are not pregnant, with urinary tract infection (U71) without abnormalities of the kidneys or urinary tract and without indications for poor immune response
Antibiotics are indicated…	In patients with cough (R05, R77, R78) and CRP >100	In patients with sinus complaints (R09, R74, R75) and CRP >100	In patients with urinary tract infection (U71) who are male, or pregnant, or have abnormalities of the kidneys or urinary tract, or indications for poor immune response
Remarks	Not all measured CRP values are recorded. CRP limits for indications are only applied if CRP values were recorded Relevant comorbidity includes: heart failure, COPD, neurological diseases, and severe kidney diseases	Being seriously ill and having prolonged or recurrent fever cannot be retrieved from NIVEL Primary Care Database and are consequently not taken into account	Signs of tissue invasion cannot be retrieved from NIVEL Primary Care Database and are consequently not taken into account. No distinction between a single bout of cystitis or recurrent cystitis is made, because in both cases antibiotics can be considered in healthy women who are not pregnant

Notes:

^aPatients are considered as having a poor immune response if at least one of the following drugs were prescribed: corticosteroids (chronic use), cytostatic drugs, DMARDs, biologicals, anti-thyroid drugs, phenytoin, neuroleptics, antivirals for systemic use, or if at least one of the following diseases was recorded: HIV infection, cancer, diabetes mellitus, severe alcohol abuse, sickle cell disease, (functional) asplenic, severe renal insufficiency.

Abbreviations: ICPC, International Classification of Primary Care; GP, general practitioner; DMARDs, disease-modifying antirheumatic drugs; NIVEL, Netherlands Institute for Health Services Research.