




































    

 American Journal of Medical and Physical Education 
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REDUCING INAPPROPRIATE ANTIBIOTIC PRESCRIBING FOR UPPER 

RESPIRATORY INFECTIONS WITH LEAFLETS 

 

 

Peter James Brown 

California State University, Bakersfield 

  

Abstract: Antibiotics are often prescribed for upper respiratory infections (URIs) in the United States, despite 

the fact that most URIs are caused by viruses and do not require antibiotics. This inappropriate prescribing 

contributes to the development of antibiotic-resistant bacteria, which can lead to more serious infections and even 

death. Antibiotics can also cause side effects, such as nausea, diarrhea, and rash. The unnecessary use of 

antibiotics also increases healthcare costs. 

Keywords: Antibiotics, Upper respiratory infections, Antibiotic resistance, Side effects, Healthcare costs 

 

Problem: Antibiotics are inappropriately prescribed for upper respiratory infections (URIs) throughout the 

United States, leading to complications like antibiotic-resistant pathogens, increased morbidity and mortality, 

adverse drug events, and increased healthcare costs (Lee et al., 2017; Meeker et al., 2016).  Upper respiratory 

infections are one of the most common conditions that primary care providers see in their practice (Meeker et al., 

2016).  Current evidence does not support the use of antibiotics for URIs because most infections are caused by 

viruses, are self-limiting, and rarely lead to serious complications (Lee et al., 2017).  As a result of overprescribing 

antibiotics, pathogens are becoming increasingly resistant to existing antibiotics, which leads to increased 

morbidity and mortality worldwide (Gonzales et al., 2013).  According to the Centers for Disease Control and 

Prevention (CDC), each year in the United States over two million people become infected with antibiotic-

resistant pathogens and as a result at least 23,000 people die (CDC, 2013).  The use of antibiotics can have 

undesired consequences from side effects, adverse reactions, and complications.  Antibiotics can cause side 

effects like nausea, diarrhea, rash, itching, photosensitivity, and abdominal discomfort.  Moreover, antibiotics can 

lead to serious complications like acute kidney injury, hepatitis, anaphylaxis and secondary infections like 

Clostridium difficile diarrhea (CDC, 2013).  The health care costs of antibiotics to treat URIs are significant in 

the United States.  Meeker et al. (2014) explains that in the United States alone, 41.2 million prescriptions for 

antibiotics aimed at treating URIs are prescribed annually.  This results in a cost of $1.1 billion dollars (Meeker 

et al., 2014).  According to the CDC (2013), one in five emergency department visits are a direct result of an 

adverse drug event from prescribed antibiotics.  In children antibiotics are the most common cause of emergency 

department visits resulting from adverse drug effects (CDC, 2013).  Unnecessary use of antibiotics increases the 

healthcare cost from the initial purchase of the antibiotic, but also the emergency department visit associated with 

possible side effects (CDC, 2013). 

There is a psychological and sociocultural variable that influences the use of antibiotics in treatment of URIs, and 

that is the desire to receive antibiotics by patients (Coxeter, Mar, & Hoffmann, 2017).  According to Coxeter, 

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Mar, and Hoffmann (2017), many patients overestimate the benefits and underestimate the harms of using 

antibiotics.  This thought process by the public leads to increased demand and desire for antibiotics, regardless of 

whether or not they are indicated.  Furthermore, patients often have inadequate knowledge and misconceptions 

about antibiotic use for URIs (Coxeter, Mar, & Hoffmann, 2017).  For example, most patients believe that 

antibiotics are beneficial in treating common respiratory infections, including the ability to cure viral infections, 

and shorten the duration of URIs (Yu et al., 2014).  Patients’ misconception about antibiotics are a strong factor 

in the overuse of antibiotics, because when they visit their primary care provider they expect to receive antibiotics 

regardless of whether or not they are indicated (Gonzales et al., 2013; O'Sullivan, Harvey, Glasziou, & 

McCullough, 2016).  

Primary interventions to reduce inappropriate use of antibiotics to treat URIs include yearly influenza 

vaccinations, pneumococcal vaccinations, proper hand hygiene, avoidance of people who are ill and overcrowded 

places, and furthermore engaging in healthy activities such as getting adequate sleep, smoking cessation, eating 

a healthy diet and exercising regularly (Wedro, 2018).    

Secondary interventions include the use of point-of-care diagnostic tests like C-reactive protein testing, rapid 

strep testing, and rapid influenza testing to determine the cause of illness, and better determine what antibiotics, 

if any, are indicated (Tonkin-Crine et al., 2017).  Other secondary interventions are aimed at relieving associated 

symptoms (e.g., fever, cough, muscle pains, malaise).  These interventions include analgesics, 

antihistamine/decongestant combinations, dextromethorphan, intranasal ipratropium bromide, saline nasal 

lavage, expectorants, zinc sulfate lozenges, and herbal products (Sexton, McClain, Hirsch, Aronson, & Melin, 

2018).  Tertiary interventions would be to avoid the use of antibiotics altogether, as this may lead to unforeseen 

complications in both the patient and general population (Sexton et al., 2018).  For example, antibiotics can cause 

adverse effects (e.g., anaphylaxis, kidney damage, C. difficile infection) to the patient, but they can also lead to 

increases in antibiotic-resistant organisms that can affect populations at a larger scale (Gonzales et al., 2013; 

CDC, 2013).   

Literature Review 

The theoretical framework that clinicians can apply to reduce inappropriate antibiotic prescriptions for URIs is 

that of Kurt Lewin’s change model theory.  The change model theory is made up of three-stages called the 

unfreezing stage, change stage, and refreezing stage (Shirey, 2013).  The unfreezing stage can be applied to 

primary care providers and patients as the stage where they are preparing to let go of a previously accepted idea 

or expectation (i.e., using antibiotics for the treatment of URIs).  This stage is necessary in order to challenge the 

beliefs, attitudes, expectations and behaviors that are seen with the use of antibiotics for URIs (Manchester et al., 

2014).  The change stage is where the actual transition of practice takes place (i.e., information about antibiotics 

and URIs is given to the patient).  This transition is supported by evidence-based research, knowledge, behaviors 

and attitudes aimed at following the new processes (Wojciechowski, Murphy, Pearsall, & French, 2016).  The 

last stage, refreezing, is where the new process (i.e., antibiotics will not be used to treat URIs) becomes the new 

practice, and efforts are made to keep the new behavior from regressing to what it used to be.  This will require 

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thorough patient education to address cultural and personal beliefs; and also changes in policies, practices and 

habits of providers caring for those patients (Manchester et al., 2014; Shirey, 2013).  

Lewin’s change model theory also has three factors that affect the direction in which change will occur: driving 

forces, restraining forces, and equilibrium (Wojciechowski et al., 2016).  Driving forces are positive forces that 

push in the direction that will cause change to happen (Manchester et al., 2014). An example of a driving force 

would be the information leaflet given to patients who are presenting with symptoms of URIs.  The information 

leaflet would act as a force pushing in the direction of the desired change (i.e., reduction in the use of antibiotics).  

Restraining forces on the other hand, are forces that push in the direction against driving forces in order to keep 

change from taking place and maintain the status quo, or equilibrium (Wojciechowski et al., 2016; Manchester et 

al., 2014).  An example of this would be the misconceptions that patients have about the use of antibiotics in 

treatment of URIs.  It is their misconception that prevents change from taking place.  Equilibrium occurs when 

the driving forces push against the restraining forces, and as a result, no change occurs (Wojciechowski et al., 

2016).   

As mentioned before, the unnecessary use of antibiotics to treat upper respiratory infections leads to consequences 

like increased drug-resistance, increased health care costs, and increased incidences of adverse effects 

(O’Sullivan, Harvey, Glasziou, & McCullough, 2016; Lee et al., 2017).  Uncomplicated URIs result in 25 million 

visits to primary care providers across the United States each year (Zoorob, Sidani, Fremont, &Kihlberg, 2013).  

In a large outpatient study of more than 52,000 cases of URIs, it was found that over 65% ofpatients received 

antibiotics, and although indicated in some cases, antibiotics are still vastly overused(Zoorob et al., 2013).  One 

reason antibiotics are overprescribed is because patients desire, and in some cases, expect to receive antibiotics 

from their providers, regardless of whether or not they are indicated (Gonzales et al., 2013; O’Sullivan et al., 

2016).  

An evidence-based review of numerous research studies aimed at reducing antibiotic prescriptions for upper 

respiratory infections was conducted using PubMed, Google Scholar, and various online resources (e.g., CDC, 

UpToDate).  From these resources, five studies were found to show that printed information given to patients 

presenting with upper respiratory infections would result in reduced prescription rates for antibiotics (Lee et al., 

2017; Wei et al., 2017; Gonzales et al., 2013; Agnew, Taaffe, Darker, O'Shea, & Clarke,2013; Meeker et al., 

2014).  The use of printed information would come in various forms, including leaflets, brochures, pamphlets, 

and a poster-size education/commitment letter (Lee et al., 2017; Wei et al., 2017; Gonzales et al., 2013; Agnew 

et al.,2013; Meeker et al., 2014).  

This evidence-based review is aimed at evaluating the use of printed information for patients, and will address 

the following research question:  Will providing information leaflets to adult patients with upper respiratory 

infections reduce the use of antibiotics?  

Lee et al. (2017) designed a patient-targeted educational pamphlet on the causes of URIs and the role of 

antibiotics, with a goal of reducing antibiotic prescriptions.  The educational pamphlet was based on information 

from the Health Promotion Board of Singapore, the CDC of the United States, and consultations from several 

primary care and infectious disease providers, and public health experts (Lee et al., 2017).  Lee et al. (2017) used 

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a randomized control trial in patients over 21 years in age, presenting with URI symptoms for seven days or less, 

who presented to the primary care clinics in Singapore (Lee et al., 2017).  Out of 457 patients who participated in 

the study, Lee et al. (2017) found that the educational pamphlet significantly reduced antibiotic prescriptions for 

URIs in a small Indian ethnic subgroup.  The rest of the participants had no significant decreases in prescription 

rates, but did increase the patients’ understanding of URIs, why antibiotics are not necessary for URI, and side 

effects of antibiotics (Lee et al., 2017). 

Wei et al. (2017) used a two-part intervention, pragmatic cluster-randomized trial aimed at reducing inappropriate 

antibiotic prescriptions for URIs in pediatric patients seeking care in primary care hospitals in China.  The first 

intervention was aimed at educating and training providers on the guidelines of treating URIs, appropriate 

prescribing, and also monthly peer-review meetings (Wei et al., 2017).  The second intervention was aimed at the 

parents of pediatric patients.  Parents were given paper leaflets about antibiotics and URIs, and at the same time, 

there was an educational video playing on a loop in the waiting rooms of the primary care hospitals (Wei et al., 

2017).  Wei et al. (2017) saw a decrease in antibiotic prescription rates from 80% to 40% among participants in 

the intervention group.  Wei et al. (2017) concluded that interventions aimed at both providers and patients were 

highly effective at reducing the prescribing rate of antibiotics for upper respiratory tract infections. 

Gonzales et al. (2013) conducted a three-arm, cluster-randomized trial aimed at reducing antibiotics for acute 

bronchitis.  The three-arms were divided into a control group (no education was provided), a printed interventions 

group in which educational brochures from the CDC were given to patients at triage and posters displaying the 

clinical algorithm for treatment of acute bronchitis were posted in every exam room (Gonzales et al., 2013).  The 

computerized group used the electronic medical record to alert the nursing staff when a chief complaint of cough 

was entered, prompting the nurse to give an educational brochure from the CDC to the patient and also alert the 

provider, via the electronic medical record, to use a specific algorithm with specific documentation, relevant 

history, and physical exam elements (Gonzales et al., 2013).  Gonzales et al. (2013) saw decreases in prescribed 

antibiotics in both the printed interventions group (80% down to 68.3%), and the computerized intervention group 

(74% down to 60.7%).  Gonzales et al. (2013) conclude that educational brochures can help reduce antibiotic 

prescription rates for upper respiratory infections. 

Agnew et al. (2013) used an intervention trial study design with 115 patients from the Dublin, Ireland area 

presenting to their primary care provider with complaints of acute respiratory tract infections.  The purpose of the 

study was to determine if delayed prescriptions and an information leaflet on antibiotics would reduce the rate of 

antibiotic use (Agnew et al., 2013).  The intervention group was given a delayed prescription for antibiotics and 

also an information leaflet.  The information leaflet contained written details explaining the role of antibiotics in 

respiratory tract infections, indications for use, and potential side effects (Agnew et al., 2013).  Agnew et al. 

(2013) called patients over the phone 10 to 14 days after their consultation, and as a result found that only 43% 

of the intervention group said they used the antibiotics they were given, concluded that the use of an additional 

information leaflet is highly effective at reducing the use of antibiotics for respiratory tract infections.  

Meeker et al. (2014) conducted a randomized clinical trial with 954 adults presenting with acute respiratory 

infections in outpatient clinics located in Los Angeles, California.  Participants were 18 years and older, diagnosed 

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with a URI for which antibiotics might or might not have been appropriate. The intervention included the use of 

a poster-size (18 x 24 inch) commitment letter explaining why antibiotics were not appropriate in many cases; 

these would be posted in examination rooms (Meeker et al., 2014).  The clinicians who were included in the 

intervention group would have their photograph and signature added to the commitment letter (Meeker et al., 

2014).The rate of antibiotic prescriptions for the intervention group (n=449) decreased from 43.5% to 33.7%, and 

Meeker et al. (2014)  Concluded that there was a significant reduction in antibiotic prescriptions for URIs for 

patients treated by clinicians who signed and posted a commitment letter in their examination rooms. The 

commitment letter was written at an eighth-grade reading level in both English and Spanish, and included 

information about antibiotics, use of antibiotics, side effects of antibiotics, increased drug-resistance due to 

antibiotics, and how it is important to “only use an antibiotic when it is necessary to treat your illness” (Meeker 

et at., 2014, p. 427).  

Discussion and Application 

According to the CDC, initial treatment of upper respiratory infections consists of watchful waiting for patients 

who can easily follow up if their condition worsens (CDC.gov, 2017).  Other interventions are aimed at 

symptomatic relief with the use of decongestants, antipyretics, non-steroidal anti-inflammatory drugs (NSAIDs), 

and cough suppressants (CDC.gov, 2017).  The use of antibiotics as initial or secondary interventions is not 

recommended for uncomplicated upper respiratory infections (CDC.gov, 2017).  According to the Infectious 

Disease Society of America (IDSA), the use of antibiotics is indicated when one or more of three criteria are met 

by the patient: (a) persistent symptoms lasting greater than 10 days; (b) onset of severe symptoms, or signs of 

high fever (≥39°C [102°F]) and purulent nasal discharge, or facial pain lasting for at least 3–4 consecutive days; 

or (c) onset of worsening symptoms like new onset of fever, headache, or increase in nasal discharge following a 

typical URI that lasted five to six days and was initially improving (Chow et al., 2012).  Both the CDC and the 

IDSA advise against the use of antibiotics for uncomplicated URIs, furthermore, the evidence-based research of 

five studies support this recommendation and attempt to curve the inappropriate use of antibiotics for URIs using 

various printed mediums (CDC.gov, 2017; Chow et al., 2012; Lee et al., 2017; Wei et al., 2017; Gonzales et al., 

2013; Agnew et al., 2013; Meeker et al., 2014).  

All five of the studies employed the use of printed information to educate patients about URIs, antibiotics, side 

effects of antibiotics, and the inappropriate use of antibiotics for treatment of URIs (Lee et al., 2017; Wei et al., 

2017; Gonzales et al., 2013; Agnew et al.,2013; Meeker et al., 2014).  Meeker et al. (2014) had one difference 

from all of the others in that the written information was posted in the exam room, and could not be taken home 

with the patient. All other of the studies provided patients with leaflets, brochures, or pamphlets that could be 

taken home (Lee et al., 2017; Wei et al., 2017; Gonzales et al., 2013; Agnew et al.,2013).  Wei et al. (2017) also 

included an educational video playing on a loop in the waiting rooms, whereas none of the other studies included 

a video medium.  Two studies, Wei et al. (2017) and Gonzales et al. (2013) also included education and training 

about antibiotics and URIs to participating clinicians.  Three studies, Lee et al. (2017), Agnew et al. (2013) and 

Meeker et al. (2014), included only adults in their sample selection, Wei et al. (2017) only included children in 

their sample selection, and Gonzales et al. (2013) included a combination of adolescents (>13 years old) and 

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adults in their sample selection.  The overall conclusion of all five studies was that providing printed information 

to patients with URIs was effective at reducing the rate of inappropriate antibiotic prescriptions (Lee et al., 2017; 

Wei et al., 2017; Gonzales et al., 2013; Agnew et al.,2013; Meeker et al., 2014).  

Providing education to patients about the use of antibiotics and URIs is the first stage of Lewin’s change model 

theory, unfreezing (Manchester et al., 2014).  This is supported by the idea that printed information given to 

patients will prepare them to let go their previously accepted ideas, or misconceptions, about using antibiotics to 

treat URIs (Manchester et al., 2014; Lee et al., 2017).  The unfreezing stage is further embodied by the use of 

guidelines and data showing the consequences of current antibiotic use (e.g., increased drug-resistance, adverse 

effects, and costs) (Wojciechowski et al., 2016; O'Sullivan et al., 2016).  The change stage is where the education, 

implementation and presenting of the idea that antibiotics should not be used to treat URIs takes place.  This stage 

includes the use of evidence-based research to support the idea of not using antibiotics for treatment of URIs, all 

the while fostering the new process (Wojciechowski et al., 2016).  

Meeker et al. (2014) found that clinicians were more influenced by interpersonal factors (i.e., their photograph 

and signature added to a commitment letter about antibiotics) than they were by pay-for-performance incentives.  

Lewin’s change stage would attribute this phenomenon to providers’ engagement as stakeholders and role models 

with the new process (Meeker et al., 2014; Wojciechowski et al., 2016). The last stage of Lewin’s change model 

theory, refreezing, is where the patients are encouraged and motivated by the resources they are given to accept 

the idea that antibiotics should not be used for treatment of URIs, with examples like the risks vs benefits of 

antibiotics, the selflimiting etiology of URIs, and the need to decrease antibiotic-resistance (Manchester et al., 

2014; Wojciechowski et al., 2016).  

Implications for practice are aimed at reducing antibiotic prescriptions for URIs.  The use of printed information, 

like leaflets, are aimed at educating patients about the pathogenesis of URIs, lack of evidence showing that 

antibiotics are useful in treating URIs, side effects, complications, and cost of unnecessary utilization of 

antibiotics (Lee et al., 2017; Wei et al., 2017; Gonzales et al., 2013; Agnew et al., 2013; Meeker et al., 2014). 

Clinicians can use printed information (e.g., pamphlets, leaflets, brochures) to educate patients about antibiotics 

and URIs, which in turn will help reduce patient desire for antibiotics and decrease inappropriate use of antibiotics 

(Lee et al., 2017; Wei et al., 2017; Gonzales et al., 2013; Agnew et al.,2013; Meeker et al., 2014).  Printed 

information in the form of leaflets has been found to be very useful in educating patients, especially for acute 

conditions where the patients are misinformed or lack knowledge (Sustersic, Gauchet, Foote, & Bosson, 2017). 

Sustersic et al. (2017) conducted a systemic review of 986 articles and found that printed information leaflets 

improved patients’ knowledge, satisfaction, adherence to treatment for acute conditions, and also improved 

patients’ behaviors for chronic diseases.  Information leaflets are inexpensive and easily prepared interventions 

that can help reduce overall health care costs in the primary care setting (Sustersic et al., 2017).  Clinicians can 

write, develop and implement information leaflets, in both English and Spanish, to help educate their patients, 

curve desires for antibiotics, and inappropriate antibiotic use (Lee et al., 2017; Wei et al., 2017; Gonzales et al., 

2013; Agnew et al.,2013; Meeker et al., 2014).  

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The healthcare system in the United States can be described as a hybrid system of various payers, including 

private, business, and government, operating simultaneously and interactively (Department for Professional 

Employees [DPE], 2016).  There are multiple levels that exist within the government-funded healthcare system, 

among them are local, state and federal.  At the federal level, we have Medicare; at the state level, we have 

Medicaid (i.e., Medi-Cal in California). Within the United States healthcare system, there are various pay models. 

One example is the fee-for-service model which reimburses clinicians a set amount for each of the services they 

perform, regardless of patient health outcomes (HealthCare.gov, n.d.).  Another model is the pay-for-performance 

model in which providers have financial incentives based on improving patient health outcomes (Bardach et al., 

2013).  A new model from the Centers for Medicare and Medicaid Services (CMS) is the capitated model, in 

which a provider, or group of providers, receive a monthly fixed amount of money to provide comprehensive care 

(i.e., outpatient, inpatient, preventative services, diagnostic and treatment services) to each patient assigned to 

them (CMS, 2017).  

In capitated models there is a pool of money that is collected and held until the end of the year.  If the overall 

healthcare costs of the patients are low, financial rewards are given to the providers, whereas if the overall 

healthcare costs are high, the financial rewards for providers are minimal (CMS, 2017).  The use of capitated 

models can influence clinicians’ decisions on care.  On one hand, clinicians are asked to provide quality care, but 

on the other hand they are asked to manage that care while being cost-effective.  This dilemma may cause 

clinicians to prescribe antibiotics when they are not indicated (i.e., for treatment of a URI) in order to keep their 

patient’s health from getting worse, which could lead to a hospitalization.  For example, if a patient with a URI 

was seen by a provider and was not prescribed antibiotics, there is a small possibility that they could develop 

pneumonia and require hospitalization (Gonzales et al., 2013).  A clinician, incentivized by the capitated model, 

may be more inclined to prescribe antibiotics in order to prevent the expensive and costly hospitalization of a 

more serious infection.  The capitated reimbursement environment may lead providers to err on the side of caution 

and prescribe unnecessary antibiotics for URIs. Since the implementation of the Affordable Care Act (ACA) in 

2014, there has been an increasing trend in healthcare to deliver customer-centered care aimed at increasing 

patient satisfaction (Detsky & Shaul, 2013).  

The ACA includes a provision that will redistribute up to 1% of Medicare reimbursements from the hospitals with 

the lowest patient satisfaction scores to hospitals with the highest patient satisfaction scores (Detsky & Shaul, 

2013).This environment of patient satisfaction and customer-centered care, has led providers to chase financial 

incentives derived from institutional pressures, reimbursement schemes, discretionary care (i.e., medical 

interventions that have no proven benefit), and the desire to avoid bad ratings from customers (Detsky & Shaul, 

2013).  

Clinicians will find themselves in a conflicting healthcare environment, where on one hand they are asked to 

improve patient satisfaction, but on the other hand they must deliver quality care. This dilemma further aggravates 

the issue of prescribing antibiotics for URIs when patient satisfaction is such a strong variable. If a patient is not 

given a prescription to treat their upper respiratory infection, they may be more inclined to give the provider a 

low satisfaction score.  Conversely, providers may be more willing to give their patients a prescription of 

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antibiotics for URIs if there is an opportunity to receive a higher satisfaction score, as this may lead to more 

financial compensation.  

The use of printed information has shown promising results at both educating patients and reducing prescriptions 

for inappropriate antibiotics for URIs (Lee et al., 2017; Wei et al., 2017; Gonzales et al., 2013; Agnew et al.,2013; 

Meeker et al., 2014).  There are many variables that need to be addressed in regards to this issue. Among them 

are patients, providers, institutions, policies, and payers.  The need for further research aimed at multiple parties 

(i.e., patients, providers, and organizations) would be beneficial to address the issue from different angles.  Also, 

the use of information leaflets may be considered archaic when compared to the present day smart phones and 

digital applications.  The use of smart phones, digital applications, emails, and text messages to deliver the same 

information found on leaflets may be beneficial to a younger and more technologically savvy population, 

furthermore suggesting the need for additional studies to verify the efficacy of these digital interventions.  

Intervention Recommended for Clinicians  

Clinicians can use printed information leaflets to educate patients on URIs, antibiotics, indications for antibiotics, 

and complications that can arise from antibiotics.  The information leaflets for this intervention would be written 

at an eight-grade reading level, and would contain information from various resources aimed at providing 

guidelines for clinicians (e.g., CDC, National Institutes of Health, and IDSA).  The information leaflet would be 

written in both English and Spanish, as this will help capture a larger population of patients.  The leaflet would 

have detailed information about the causes of URIs, disease progress, and symptomatic management.  It would 

also have descriptions of how antibiotics function, their side effects, possible complications that may arise, and 

how they are not indicated for URIs because they are often times caused by viruses.  All of this information will 

be written in a way that patients can easily read, understand and discuss with their providers.  Clinicians will be 

asked to help clarify any misconceptions, explain the information, and answer any questions patients may have 

about the information found on the leaflet.  The leaflet can be given to patients at various points of contact 

throughout their visit in the primary care setting.  The triage staff can provide the leaflet if the patient presents 

with a chief complaint of cough or cold-like symptoms.  The leaflets can also be placed in easily accessible areas 

of the waiting room and examination rooms, to encourage patients to take one freely.  Lastly, the clinician can 

also hand a leaflet to the patient and discuss its content throughout the consultation.  

The strengths of the information leaflets would have to be that it is easy to read and understand, precise and 

straight to the point, and readily available to anyone.  Another benefit is the low-cost of printing copies, and the 

unnecessary purchase of new equipment (e.g., computers, tablets, smart phone applications).  Some of the 

weaknesses found in leaflets are that in a digital age, paper mediums are often overlooked.  They are also discarded 

after being read and are seldom kept for reference.  Also, patients who are illiterate would not be able to read and 

comprehend the information provided in the leaflet.  Lastly, the discussion and explanation of the leaflet between 

the provider and the patient is paramount to the efficacy and outcome it aims to achieve.  Clinicians can use the 

leaflet to educate and curve patients’ desires for antibiotics, which in turn will help reduce inappropriate 

antibiotics for upper respiratory infections.  

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