Table 1.

Recommendations for prescribing of antibiotics for acute cough, allergic and non-allergic rhinitis, acute rhinosinusitis and acute sore throat and study definitions.

	Guideline
	Acute Cough, (M78, 2011) [14]	Allergic and non-Allergic Rhinitis (M48, 2006) [16]	Acute Rhinosinusitis, (M33, 2014) [14]	Acute Sore Throat (M11, 2015) [15]
Diagnoses included in the guideline (ICPC)	Acute cough (R05), Whooping cough (R71), Laryngitis/tracheitis acute (R77), Acute bronchitis/bronchiolitis (R78)	Sneezing/nasal congestion (R07), Nose symptom/complaint other (R08) Allergic rhinitis (R97)	Sinus symptom/complaint (R09), Upper respiratory infection acute (R74), Sinusitis acute/chronic (R75)	Throat symptom/complaint (R21), Tonsils symptom/complaint (R22), Strep throat/scarlet fever (R72), Tonsillitis acute (R76)
Antibiotics recommen-dations 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.	Antibiotics are not mentioned in the guideline.	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.	In principle, no antibiotics. Antibiotics are indicated • in seriously ill patients • if advised by public health services in the rare case of scarlet fever clusters in a closed community. Antibiotics can be considered in patients with an increased risk of complications, e.g., in case of: • Chronic use of corticosteroids or other immunosuppressive medicines • HIV infection with a reduced number of T-cells • Chemotherapy or radiotherapy • Cancer • Immune disorders • Diabetes mellitus • Rheumatic fever • Severe alcohol abuse • Drug abuse • Functional asplenic • sickle cell disease
Study definitions Antibiotics not indicated	in patients with cough (R05, R77, R78) between three months and 75 years, without indications for poor immune response *, with CRP <20 and without relevant comorbidity.	in all patients	in patients with sinus complaints (R09, R74, R75) without indications for poor immune response *.	in patients with sore throat complaints (R21, R22, R72, R76) without indications for poor immune response * and without rheumatic fever in their medical history.
Study definitions Antibiotics possibly indicated	in patients with cough (R05, R77, R78) younger than three months or 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).	not applicable	in patients with sinus complaints (R09, R74, R75) with an indication for poor immune response *.	in patients with sore throat complaints (R21, R22, R72, R76) with an indication for poor immune response * or with rheumatic fever in their medical history.
Study definitions 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.	not applicable	Being seriously ill and having prolonged or recurrent fever cannot be retrieved from Nivel Primary Care Database and are consequently not taken into account.	Being seriously ill cannot be retrieved from Nivel Primary Care Database and is consequently not taken into account. The same holds for scarlet fever clusters in a closed community.

* Patients are considered as having a poor immune response if at least one of the following drugs were prescribed as described in the guideline: 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.