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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 45, Respiratory Tract Infections, Upper.



  • image Many upper respiratory tract infections will resolve spontaneously without pharmacologic therapy.

  • image The most common bacterial causes are Streptococcus pneumoniae (acute otitis media and acute rhinosinusitis) and group A β-hemolytic Streptococcus (acute pharyngitis).

  • image Vaccination against influenza and pneumococcus may decrease the risk of acute otitis media.

  • image Because upper respiratory tract infections are so common, antibiotics used to treat them serve as catalysts for the emergence and spread of antibiotic resistance, thereby making prudent antibiotic use critically important.

  • image When antibiotics are prescribed, the empirical medications of choice are amoxicillin or amoxicillin-clavulanate for acute otitis media, amoxicillin-clavulanate for acute rhinosinusitis, and amoxicillin or penicillin for acute pharyngitis.

  • image For acute otitis media, high-dose amoxicillin (80-90 mg/kg/day in two divided doses) is recommended.


Preclass Engaged Learning Activity

Create a summary table of first-line drug treatment options, including recommended treatment if the patient has a penicillin allergy, for the upper respiratory tract infections discussed in this chapter: acute otitis media, rhinosinusitis, and pharyngitis. The table should include columns for type of upper respiratory tract infection, first-line treatment, dose, route, and duration of treatment. The table should also include important counseling points and adverse effects.


More patients present to physicians’ offices and emergency departments for upper respiratory tract infections than any other infectious disease. There are over 25 million office visits per year for acute upper respiratory tract infections.1 Otitis media, rhinosinusitis, and pharyngitis are the three most common upper respiratory tract infections. Because they are so common, community and emergency healthcare workers must be familiar with the diagnosis, assessment, and management of patients with these infections. Furthermore, antibiotics used for the treatment of upper respiratory tract infections serve as catalysts for the emergence and spread of antibiotic resistance, thereby making prudent antibiotic use critically important.


The term otitis media comes from the Latin oto- for “ear,” itis for “inflammation,” and medi- for “middle”; otitis media, then, is an inflammation of the middle ear. There are three subtypes of otitis media: acute otitis media, otitis media with effusion, and chronic otitis media. Acute otitis media is the subtype with the greatest role for antibiotics and will be discussed in detail.


Otitis media is one of the leading reasons for physicians’ office visits and emergency department visits in the United States. There are more than 709 million cases of otitis media worldwide each year; half of these cases occur in children under 5 years of age.2 Many patients with otitis media will receive a prescription, and the costs ...

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