New guide for antibiotic use for pediatric URIs

Making the appropriate diagnosis is critical to the optimal use of antibiotics in children who have upper respiratory tract infections (URIs), according to a new clinical report.

The report was issued by the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) in conjunction with Get Smart About Antibiotics Week. Titled “Principles of judicious antibiotic prescribing for bacterial upper respiratory tract infections in pediatrics,” the committee outlines when antibiotics are appropriate for otitis media, sinusitis, and pharyngitis, with emphasis on first determining the likelihood that an infection is bacterial, rather than viral, in nature.

With acute otitis media, the researchers say that those children with more severe symptoms, bilateral involvement, and younger age are more likely to benefit from antibiotics.

With acute sinusitis, the investigators emphasize that bacterial forms are diagnosed on the basis of symptoms that are persistent and not improving (eg, a cough lasting 10 days); worsening (eg, new onset of fever, daytime cough, or nasal discharge after improvement of a typical viral URI); or severe (eg, persistent fever ≥39°C or purulent nasal discharge for at least 3 days).

And with pharyngitis, the committee notes that the most important diagnostic consideration is whether ß-hemolytic group A Streptococcus is the cause. Children with 2 or more of the following features should undergo testing: absence of cough, presence of tonsillar exudates or swelling, history of fever, presence of swollen or tender anterior cervical lymph nodes, and age younger than 15 years. Children with cough, nasal congestion, conjunctivitis, hoarseness, diarrhea, or otopharyngeal lesions are more likely to have viral illness.

The CDC reports that each year as many as 10 million children risk side effects and antibiotic resistance by taking antibiotics that are unlikely to do anything for their upper respiratory conditions.

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