Guidelines for the Judicious Use of Antibiotics for Upper Respiratory Infections and Other Related Diseases in Children

The common cold Antibiotics are not needed. Pharyngitis and tonsillitis 1) Most cases of pharyngitis/tonsilitis are viral infections. There is no need for antibiotics except when group A beta-hemolytic streptococcus (GABHS) is the causative pathogen. 2) In the case of GABHS infection, benzylpenicillin benzathine is the first-line agent. Acute otitis media Follow up with symptomatic treatment only. If the symptoms (otalgia or fever) have not subsided within 48-72 hours, administrate an antibiotic. In case the symptoms (otalgia, fever or sickness) have worsened during the observation period, examine the patient immediately. Acute sinusitis Most cases of acute sinusitis are viral infections. Do not use antibiotics for the first 10-14 days, even if purulent nasal discharge is present. Cough illness/bronchitis 1) Most of cough illness/bronchitis are caused by viral infections. Antibiotics are not justified for the treatment. 2) Erythromycin is recommended if pertussis is suspected. Fever without source Observe patient’s condition without administering antibiotics. However, when one of the findings below is present, intravenous ceftriaxone is our recommendation: 1) Infants of 3-12 months old with either a temperature of ≧40°C, or 38.5°C or more and leukocyte count of ≧15,000/μl ( or neutrophil count of ≧10,000/μl). 2) Infants of 12-36 months old with a temperature of ≧39°C and leukocyte count of ≧15,000/μl (or neutrophil count of ≧10,000/μl).