A clinical report from the American Academy of Pediatrics
(AAP), in collaboration with the Centers for Disease Control and Prevention,
offers updated guidance on treating respiratory tract infections in children,
with the goal of reducing unnecessary antibiotics prescriptions.
The clinical report, “Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics,”
published in the December 2013 Pediatrics and released online Nov. 18, advises
physicians to use stringent diagnostic criteria to distinguish between viral and
bacterial infections. The report focuses on three of the most common pediatric
upper respiratory infections: ear infections, sinus infections and strep
”This report is particularly timely as we enter the winter
season, when many respiratory viruses commonly circulate,” said Mary Anne
Jackson, MD, FAAP, a member of the AAP Committee on Infectious Diseases and a
lead author of the report. “By using these principles, physicians will be able
to more appropriately diagnose and treat otitis media, sinusitis and strep
Studies have shown that as many as 10 million antibiotic
prescriptions are written each year for infections they are unlikely to help.
Recent evidence shows that prescriptions for broad-spectrum antibiotics have
increased, even when no antibiotics are needed or when a narrow-spectrum
antibiotic would work. Overuse of antibiotics contributes to antibiotic
resistance, making infections more difficult to treat.
Symptoms of the common cold, which is viral in nature, often
persist for 10 days. According to the AAP, physicians treating such
illnesses should focus on relieving symptoms and not prescribe antibiotics.
Earlier in 2013, the AAP issued two new sets of clinical
practice guidelines on acute
otitis media and bacterial
sinusitis, which include explicit criteria to help physicians make an
accurate diagnosis and determine when antibiotics are needed. The key
recommendations of those guidelines are included in the Nov. 18 clinical
report, which also adds guidance on diagnosing and treating strep throat.
The judicious antibiotic principles outlined by the AAP can
be applied broadly to antibiotic use in general. They include using stringent
diagnostic criteria, weighing the benefits and harms of antibiotics, and
choosing the appropriate dose of antibiotic for the shortest duration
“This is an important resource that provides guidance for
clinicians, and will help in communication with families to make the best use
of antibiotics,” Dr. Jackson said. “Physicians and parents are increasingly
aware of the risk of antibiotics and the impact on growing antibiotic
Note: During November 18-24, 2013, the AAP joins the Centers for Disease
Control and Prevention and its public health and professional partners in
observing Get Smart About Antibiotics Week. Each year in the United States, at
least 2 million people become infected with antibiotic-resistant bacteria.
According to the CDC, at least 23,000 people die as a direct result of these
infections, and many more people die from other conditions that were
complicated by an antibiotic-resistant infection. Improving antibiotic use has
many important benefits, including improved cure rates, fewer adverse drug
events, and reduced antibiotic resistance. Learn more about Get Smart About
Antibiotics Week at www.cdc.gov/getsmart