Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics

Pediatrics. 2013 Dec;132(6):1146-54. doi: 10.1542/peds.2013-3260. Epub 2013 Nov 18.


Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.

Keywords: antibacterial agents; respiratory tract infections.

Publication types

  • Practice Guideline

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Contraindications
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Otitis Media / diagnosis
  • Otitis Media / drug therapy*
  • Otitis Media / microbiology
  • Pediatrics / methods*
  • Pediatrics / standards
  • Pharyngitis / diagnosis
  • Pharyngitis / drug therapy*
  • Pharyngitis / microbiology
  • Sinusitis / diagnosis
  • Sinusitis / drug therapy*
  • Sinusitis / microbiology
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / drug therapy*


  • Anti-Bacterial Agents