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Upon completion of the chapter, the reader will be able to:

  1. List the most common bacterial pathogens that cause acute otitis media (AOM), acute bacterial rhinosinusitis (ABRS), and acute pharyngitis.

  2. Explain the pathophysiologic causes of and risk factors for AOM, bacterial rhinosinusitis, and acute pharyngitis.

  3. Identify clinical signs and symptoms associated with AOM, bacterial rhinosinusitis, streptococcal pharyngitis, and the common cold.

  4. List treatment goals for AOM, bacterial rhinosinusitis, streptococcal pharyngitis, and the common cold.

  5. Develop an appropriate antibiotic regimen for each infection based on patient-specific data.

  6. Recommend appropriate adjunctive therapy for a patient with AOM or ABRS.

  7. Recommend an appropriate treatment plan for a patient with the common cold.

  8. Create a monitoring plan for a patient being treated for an upper respiratory tract infection (URI) using patient-specific information and prescribed therapy.

  9. Educate patients about URIs and proper use of antibiotic therapy.




  • Image not available. Most upper respiratory tract infections (URIs) are caused by viruses, have nonspecific symptoms, and resolve spontaneously.

  • Image not available. Antibiotic resistance greatly influences the treatment options for bacterial URIs.

  • Image not available. Proper diagnosis of bacterial URIs is essential to identify when antibiotic use is appropriate.

  • Image not available. Antibiotic therapy for acute otitis media (AOM) should be reserved for children who are most likely to benefit from therapy and is dependent on patient age, illness severity, and diagnostic certainty.

  • Image not available. For AOM, high-dose amoxicillin (80 to 90 mg/kg/day) is the drug of choice, but high-dose amoxicillin-clavulanate is an alternative agent for children with severe illness or when a broader spectrum agent is desired.

  • Image not available. Antibiotic therapy for sinusitis should be reserved for patients with moderate persistent symptoms, clinical decompensation, or severe symptoms.

  • Image not available. Amoxicillin and amoxicillin-clavulanate are first-line antibiotics for acute bacterial rhinosinusitis (ABRS).

  • Image not available. The goals of therapy for streptococcal pharyngitis are to eradicate infection, reduce symptoms and infectivity, and prevent complications.

  • Image not available. Penicillin is the drug of choice for streptococcal pharyngitis.

  • Image not available. Treatment for the common cold focuses on symptom relief and is influenced by patient age, comorbid conditions, and balance of medication effectiveness and safety.




Upper respiratory tract infection (URI) is a term that encompasses many upper airway infections, including otitis media, sinusitis, pharyngitis, laryngitis, and the common cold. More than 1 billion URIs occur annually in the United States, triggering millions of ambulatory care visits each year.1 Image not available. Most URIs are caused by viruses, have nonspecific symptoms, and resolve spontaneously.2 Antibiotics do not impact the resolution of viral URIs, and their excessive use for these infections has contributed to antibiotic resistance. Guidelines have been established to reduce inappropriate antibiotic therapy for viral URIs.2 This chapter focuses on acute otitis media (AOM), sinusitis, and pharyngitis because these infections are frequently caused by bacteria, and their complications can be minimized with appropriate antibiotic therapy. Proper management of the common cold is also reviewed.




Otitis media, or inflammation of the middle ear, ...

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