Use of Antimicrobial Agents for Upper Respiratory Infections in Children

Approximately three quarters of all outpatient antibiotics are prescribed for either upper respiratory tract infections (URIs) or bronchitis [1]. Antibiotic utilization rates are highest among children. Effective management of these infections has become more difficult because of the emergence of pathogens increasingly resistant to antimicrobial agents. Recent publications have provided guidance for judicious use of antibiotics for pediatric URIs [2,3] (Table). These principles stress that accurate diagnosis should be based on clinical manifestations and the use of laboratory testing when indicated. Since many infections are treated empirically, one must be knowledgeable about both the organisms likely to cause the infection and the expected antibiotic susceptibilities. Therapy should both eradicate the infecting organism and be effective in preventing any complications. The natural history of these infections needs to be understood because many infections will not require treatment with antibiotics. Curtailing unnecessary antibiotic use would protect both patients and the community from increasing bacterial antibiotic resistance. This paper will review current recommendations for the use of antimicrobial agents in 4 common pediatric conditions: acute otitis media (AOM), pharyngitis, sinusitis, and the common cold.