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Updated: Jul 16, 2025
Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity
Published on: March 16, 2018
Antimicrobial treatment of ENT infections
R Cohen1, F Madhi2, F Thollot3
1Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France.
Abstract:
Ear, nose and throat (ENT) or upper respiratory tract infections (URTI) are the most common infections in children and the leading causes of antibiotic prescriptions. In most cases, these infections are due to (or are triggered by) viruses and even when bacterial species are implicated, recovery is usually spontaneous. The first imperative is to refrain from prescribing antibiotics in a large number of URTIs: common cold, most cases of sore throat, laryngitis, congestive otitis, and otitis media with effusion. On the contrary, a decision to treat sore throats with antibiotics is based primarily on the positivity of the Group A Streptococcus (GAS) rapid antigen diagnostic tests. For ear infections, only (a) purulent acute otitis media in children under 2 years of age and (b) complicated or symptomatic forms of purulent acute otitis media (PAOM) in older children should be treated with antibiotics. Amoxicillin is the first-line treatment in the most cases of ambulatory ENT justifying antibiotics. Severe ENT infections (mastoiditis, epiglottitis, retro- and parapharyngeal abscesses, ethmoiditis) are therapeutic emergencies necessitating hospitalization and initial intravenous antibiotic therapy.
Insights
Most childhood ear, nose, and throat infections resolve on their own, reducing the need for antibiotics. Antibiotic use in upper respiratory tract infections (URTIs) should be limited, with specific criteria for treating sore throats and ear infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Upper respiratory tract infections (URTIs) are highly prevalent in children, driving frequent antibiotic prescriptions.
- Many URTIs, including the common cold and most sore throats, are viral or self-limiting, not requiring antibiotic intervention.
Purpose of the Study:
- To delineate appropriate antibiotic prescribing guidelines for pediatric ear, nose, and throat (ENT) infections.
- To reduce unnecessary antibiotic use for common childhood respiratory infections.
Main Methods:
- Review of clinical guidelines and evidence for antibiotic use in pediatric URTI and ENT infections.
- Analysis of diagnostic criteria for bacterial infections, such as Group A Streptococcus (GAS) and purulent acute otitis media (PAOM).
Main Results:
- Antibiotics are often overprescribed for viral URTIs like colds, laryngitis, and otitis media with effusion.
- Antibiotic treatment for sore throat should be guided by positive rapid antigen diagnostic tests for Group A Streptococcus (GAS).
- Antibiotics are indicated for purulent acute otitis media (PAOM) in children under 2 years and complicated cases in older children. Amoxicillin is a common first-line treatment.
Conclusions:
- Judicious antibiotic prescribing is crucial for pediatric ENT and URTI management, reserving antibiotics for specific bacterial infections.
- Early identification of GAS and appropriate management of PAOM are key to effective antibiotic stewardship.
- Severe ENT infections necessitate immediate hospitalization and intravenous antibiotics.
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