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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, ABRS, and streptococcal pharyngitis.

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

  4. List treatment goals for AOM, ABRS, 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 with a URI based on patient-specific information and the treatment regimen.

  7. Formulate appropriate educational information for 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 antibiotic prescriptions each year, of which up to 50% are considered inappropriate for use for acute respiratory conditions.1 Image not available. 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 and national campaigns to reduce inappropriate prescribing.3-7 This chapter focuses on acute otitis media (AOM), sinusitis, and pharyngitis, which are frequently caused by viruses but may be 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 noninfectious middle ear effusion. Antibiotics are only useful for the treatment of AOM.

Epidemiology and Etiology

AOM occurs in all ages but is most common between 6 and 18 months of age. By 3 years of age, about 60% of children have had at least one episode of AOM and nearly 25% have had at least 3 episodes of AOM.8 Many risk factors (Table 72–1) predispose children to otitis media.8,9 While the use of antibiotics for otitis media has declined since the mid-1990s, the proportion of health care visits resulting in antibiotic prescriptions for AOM remains high between 60% and 80%.1,10

Table 72–1Risk Factors for Otitis Media8,9

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