Upper respiratory tract Infections — rational antimicrobial use
Infectious diseases
ACG
25 May 2026
This ACE Clinical Guideline (ACG) provides guidance on appropriate antimicrobial use for treating upper respiratory tract infections (URTIs) in primary and generalist care settings, highlighting situations where antimicrobial therapy can be safely withheld, and other instances where timely administration of antimicrobial therapy may be beneficial.
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Upper Respiratory Tract Infections – rational antimicrobial use (May 2026) [PDF]
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ACG recommendations
Assess patients’ clinical signs and symptoms and establish a working diagnosis (e.g. uncomplicated URTI, acute rhinosinusitis, pharyngotonsillitis, acute otitis media).
Do not prescribe antibiotics for patients with uncomplicated URTI.
For patients with acute rhinosinusitis, pharyngotonsillitis or acute otitis media:
When a bacterial infection is clinically suspected, consider if an antibiotic is needed based on clinical features and individual risk factors for severe disease outcome.
Do not routinely prescribe antivirals for otherwise healthy patients with uncomplicated URTI.
ACG references and Expert Group details
URTI ACG references (May 2026) [PDF]
URTI ACG EG composition and other details (May 2026) [PDF]
ACG EtR framework
The Evidence-to-Recommendation (EtR) framework is a document that outlines the underpinning evidence and rationale for the recommendations in our ACGs. Download the EtR framework below to learn more about factors that have informed the strength of the ACG recommendations, including certainty of evidence, clinical benefit/risk balance, local resource implications, feasibility considerations, patient preferences and values, acceptability and other considerations.
URTI EtR framework with summary of findings (May 2026)
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