An approach to pediatric upper respiratory infections

Upper respiratory tract infections are the most common diseases encountered in office pediatrics. The majority of these illnesses, including the common cold and pharyngitis, are viral in etiology, present with rhinitis and fever, and are self-limited and benign. Management consists of fluids, rest, saltwater nose drops and analgesics. Antihistamines appear to relieve only those symptoms potentiated by allergy. With the exception of streptococcal pharyngitis, upper respiratory tract infections do not require antibiotic therapy. However, otitis media and sinusitis, which sometimes are difficult to diagnose, are markedly improved by antibiotics that cover Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In 10 percent of children, otitis media and sinusitis are recalcitrant to antibiotic therapy. For these patients, referral to an otolaryngologist, myringotomy, placement of tympanostomy tubes or a short trial of prednisone may be efficacious.