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

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

  2. Explain the pathophysiology of and risk factors for AOM, bacterial rhinosinusitis, and streptococcal 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 a treatment plan for a patient with an upper respiratory tract infection (URI) based on patient-specific information.

  6. Create a monitoring plan for a patient being treated for a URI using patient-specific information and prescribed therapy.

  7. Educate patients about URIs and proper antibiotic use.


Upper respiratory tract infection (URI) is a comprehensive term for upper airway infections, including otitis media, sinusitis, pharyngitis, laryngitis, and the common cold. Over 1 billion URIs occur annually in the United States, triggering millions of ambulatory care visits and antibiotic prescriptions each year.1 KEY CONCEPT Most URIs are caused by viruses, have nonspecific symptoms, and resolve spontaneously.2 Antibiotics are not effective for viral URIs, and their excessive use has contributed to resistance, which has prompted development of clinical guidelines to reduce inappropriate prescribing. This chapter focuses on acute otitis media (AOM), sinusitis, and pharyngitis which are frequently caused by bacteria. Proper management of the common cold is also reviewed.


Otitis media, or middle ear inflammation, is the most common childhood illness treated with antibiotics. It usually results from a nasopharyngeal viral infection and can be subclassified as AOM or otitis media with effusion (OME). AOM is a rapid, symptomatic infection with effusion, or fluid, in the middle ear. OME is not an acute illness but is characterized by middle ear effusion. Antibiotics are only useful for the treatment of AOM.


AOM occurs in all ages but is most common between 6 months and 2 years of age. By 3 years of age, more than 80% of children have at least one episode, and up to 65% have recurrent infections by 5 years of age.3,4 Many risk factors (Table 72–1) predispose children to otitis media.4,5 While the use of antibiotics for otitis media has declined since the mid-1990s, the proportion of health care visits resulting in antibiotic prescriptions remains close to 60%.6,7,8

Table 72–1Risk Factors for Otitis Media4,8

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