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  • image Many upper respiratory tract infections are due to viral etiologies and 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 Distinguishing between viral and bacterial causes for upper respiratory tract infections may be difficult, and antimicrobials are often prescribed inappropriately leading to antimicrobial resistance.

  • image When antimicrobials are indicated, amoxicillin or amoxicillin-clavulanate is first-line 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.


Watch the videos entitled “What is an upper respiratory infection (URI)?”, “What is sinusitis?”, and “Pharyngitis” in Khan Academy. These videos provide an overview of common URI. Compare and contrast infectious etiologies, diagnoses, and clinical presentation of these conditions.


Upper respiratory tract infection is the most common reason for visits to primary care providers. 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. Although most upper respiratory tract infections typically manifest as mild illnesses, their high incidence and transmissibility places these infections as a leading cause of missed work or school days. The majority of these illnesses are caused by viruses; however, distinguishing patients with viral versus bacterial infection poses challenges as signs and symptoms are generally similar. Upper respiratory tract infections remain the leading condition for antibiotic prescribing, often inappropriately, and thereby serve as catalysts for the emergence and spread of antibiotic resistance. The prudent use of antibiotics for upper respiratory tract infections is critically important.


Acute 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.


Acute otitis media is primarily an infection during childhood and is the most common pediatric infection for prescribing an antibiotic 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 Most cases of acute otitis media occur in young children ages 6 to 24 months. Fortunately, the incidence of acute otitis media has declined over the past two decades, and a downward trend in acute otitis media healthcare visits have been observed ...

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