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  • Image not available. Most upper respiratory tract infections have a viral etiology and tend to resolve spontaneously without pharmacologic therapy.
  • Image not available. The most common bacterial causes are Streptococcus pneumoniae (acute otitis media and acute sinusitis) and group A β-hemolytic Streptococcus (acute pharyngitis).
  • Image not available. Vaccination against influenza and pneumococcus may decrease the risk of acute otitis media.
  • Image not available. 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 not available. When antibiotics are prescribed, the empiric medications of choice are amoxicillin for acute otitis media and acute sinusitis and penicillin for acute pharyngitis.
  • Image not available. For otitis media, high-dose amoxicillin (80–90 mg/kg/day) is recommended if the patient is at high risk for a penicillin-resistant pneumococcal infection.

Upon completion of the chapter, the reader will be able to

  • 1. Name the most common infectious pathogens in acute otitis media, sinusitis, and pharyngitis.
  • 2. Identify risk factors for amoxicillin-resistant bacteria in acute otitis media.
  • 3. Differentiate between patients with acute otitis media and those with otitis media with effusion.
  • 4. Develop a treatment plan for a patient with acute otitis media.
  • 5. Recommend therapy for a patient with acute otitis media who fails treatment with amoxicillin.
  • 6. Defend the role of vaccination for the prevention of upper respiratory tract infections.
  • 7. Delineate viral and bacterial sinusitis based on patient history.
  • 8. Decide if an acute bacterial sinusitis infection is complicated or uncomplicated.
  • 9. Select the appropriate therapy for a patient with uncomplicated acute bacterial sinusitis.
  • 10. Suggest nonprescription medications for patients when antibiotics are not prescribed.
  • 11. Use a patient’s history and clinical presentation to gauge the likelihood of Group A β-hemolytic streptococci (GABHS) pharyngitis.
  • 12. Develop a therapeutic plan, including supportive care, for a patient with GABHS pharyngitis.
  • 13. Ascertain the need for GABHS diagnostic testing.
  • 14. Counsel a patient regarding the timeframe for GABHS incubation and infectivity.
  • 15. Select an appropriate antibiotic and dose for recurrent GABHS in adults and children.

Patients visit medical clinics and emergency rooms more for upper respiratory tract infections than any other reason.1,2Otitis media, sinusitis, and pharyngitis are the three most common upper respiratory tract infections. Other, less common infections are laryngitis, rhinitis, and epiglottitis. Because they are so common, community and emergency healthcare workers must be familiar with the diagnosis, assessment, and management of 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. The three are differentiated ...

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