The American Academy of Pediatrics has laid out three simple principles for prescribing antibiotics to children with upper respiratory tract infections. The recommendations, published in Pediatrics, are intended to address the growing threat of antibiotic resistance.
The principles include determining the likelihood that the infection is caused by bacteria, weighing the benefits of prescribing versus the risks, and prescribing antibiotics judiciously.
•For acute otitis media, the AAP recommends that clinicians consider watchful waiting for children aged 2 years or older and those with mild-to-moderate symptoms and unilateral disease.
•For bacterial sinusitis, antibiotics are recommended in children with clinical features of acute illness, particularly worsening or severe symptoms. Observation or antibiotics can be considered in patients whose symptoms have lasted over 10 days.
•For pharyngitis, the AAP recommends antibiotics after laboratory confirmation of group A Streptococcus.
Deborah Lehman, a pediatric infectious diseases specialist with NEJM Journal Watch, comments: "For some infections — severe otitis media, worsening or severe sinusitis, and strep pharyngitis — antibiotics are indicated, but physicians should apply stringent criteria when making these diagnoses, and the prescribing of broad-spectrum antibiotics for these conditions is discouraged."