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Content Update

September 29, 2022

Approval of the Combination Nirmatrelvir/Ritonavir (Paxlovid™) for the Treatment of COVID-19 in the Outpatient Setting: In December 2021, the treatment combination nirmatrelvir/ritonavir (Paxlovid™) received emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for the treatment of COVID-19 in adults and children over 12 years of age. The combination pill consists of nirmatrelvir, a 3C-like protease inhibitor which inhibits viral replication, and ritonavir, a protease inhibitor with pharmacokinetic boosting effects. Certain patient criteria must be met prior to prescribing. As of July 6, 2022, the EUA was revised giving licensed pharmacists prescriptive authority for the agent.



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 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.2-7 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 can be subclassified as otitis media with effusion (OME) or AOM. OME is characterized by the presence of a noninfectious effusion, or fluid, in the middle ear and is not an acute illness. AOM is a rapid, symptomatic infection with middle ear effusion that usually results from an initial nasopharyngeal viral infection. Antibiotics are only useful for the treatment of some AOM episodes. While the use of antibiotics for otitis media has declined since the mid-1990s, antibiotic prescription rates remain as high as ...

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