Upper respiratory tract Infections — rational antimicrobial use

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.

Download the ACG

Upper Respiratory Tract Infections – rational antimicrobial use (May 2026) [PDF]

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ACG Survey

We invite all readers of the ACGs to complete this survey. The survey aims to understand the impact of the guideline on clinical confidence, decision-making, and practice. Results will contribute to informing future guidelines and implementation support for you. Your responses will remain confidential and will be analysed in aggregate to safeguard your privacy.

The survey takes approximately 10–15 minutes to complete and will remain open for four weeks until 19 June 2026. We highly encourage you to complete the survey after reading the ACG.

ACG recommendations

1. Assess patients’ clinical signs and symptoms and establish a working diagnosis (e.g. uncomplicated URTI, acute rhinosinusitis, pharyngotonsillitis, acute otitis media).

2. Do not prescribe antibiotics for patients with uncomplicated URTI.

3. 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.

4. 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)