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  • image Most upper respiratory tract infections have a viral etiology and tend to 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 for acute otitis media, amoxicillin–clavulanate for acute rhinosinusitis, and amoxicillin and penicillin for acute pharyngitis.
  • image 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.

On completion of the chapter, the reader will be able to:

  1. Name the most common infectious pathogens in acute otitis media, rhinosinusitis, 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 rhinosinusitis based on patient history.

  8. Select the proper dose of amoxicillin and amoxicillin–clavulanate for patients with upper respiratory tract infections.

  9. Determine when to refer a patient with acute bacterial rhinosinusitis to a specialist.

  10. Suggest nonprescription medications for patients with rhinosinusitis when antibiotics are not prescribed.

  11. Use a patient’s history and clinical presentation to gauge the likelihood of 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 time frame for GABHS incubation and infectivity.

  15. Select an appropriate antibiotic and dose for recurrent GABHS in adults and children.

More patients present to physicians’ offices and emergency departments for upper respiratory tract infections than any other infectious disease.1,2Otitis media, rhinosinusitis, and pharyngitis are the three most common upper respiratory tract infections. Because they are so common, community and emergency health care 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. The three are differentiated by (a) acute signs of infection, (b) evidence of middle ear inflammation, and (c) presence of fluid ...

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