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PEDIATRICS Vol. 101 No. 1 Supplement January 1998, pp. 163-165

Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections

Received Aug 8, 1997; accepted Sep 11, 1997.

Scott F. Dowell*, S. Michael MarcyDagger , William R. Phillips§, Michael A. Gerberparallel , and Benjamin Schwartz*

From the * Childhood and Respiratory Diseases Branch, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Dagger  Kaiser Permanente, Panorama City, California; § Northwest Family Medicine, Seattle, Washington; and parallel  Connecticut Children's Medical Center, Hartford, Connecticut.

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account for the majority of outpatient antimicrobial use in the United States. Data from the National Center for Health Statistics indicate that in recent years, approximately three fourths of all outpatient antibiotics have been prescribed for otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection. Antimicrobial drug use rates are highest for children; therefore, the pediatric age group represents the focus for the present guidelines. The evidence-based principles presented here are focused on situations in which antimicrobial therapy could be curtailed without compromising patient care. They are not formulated as comprehensive management strategies. For most upper respiratory infections that require antimicrobial treatment, there are several appropriate oral agents from which to choose. Although the general principles of selecting narrow-spectrum agents with the fewest side effects and lowest cost are important, the principles that follow include few specific antibiotic selection recommendations.

Key words: antimicrobial resistance, antimicrobial use, upper respiratory infection, otitis media, pediatrics, sinusitis.


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