Antibiotic Choices in an Outpatient Community with Acquired Respiratory Tract Infections in Turkey

The purpose of this article is to bring up the efficacy of antimicrobials and the therapeutic problems that the antibiotic resistance imposes on clinicians for acute bacterial sinusitis (ABS), acute otitis media (AOM), and outpatient community acquired pneumonia (CAP) in adults in Turkey. The publications associated with respiratory pathogens on which this paper focuses were searched for in both Turkish (Ulakbim and Pleksus) and International (Medline) databases along with the presentations in national congress books related with both microbiology and infectious diseases. Amoxicillin seems to be an incompatible choice in Turkey due to high beta lactamase production either in H. influenzae or M. catarrhalis isolates, although it is very efficient for pneumococci. Amoxycillin clavulanate, extended spectrum cephalosporins (cefuroxime, ceftriaxone, cefotaxime), and respiratory quinolones appear to be more reliable options for ABS, AOM and CAP in Turkey. Countrywide macrolide resistance incidence is around 15% and macrolides should be used with caution. When an atypical component is suspected, either the addition of a macrolide or doxycyclin to beta lactams or using macrolides with caution can be considered in outpatient CAP. Finally, trimethoprim-sulfamethoxazole, and tetracyclines are not suitable alternatives.