American Academy of Pediatrics Issues Updated Guidance on Treating URIs

Posted by The Evidence Blog on January 2, 2014

The American Academy of Pediatrics (AAP), an organization of 60,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists just released updated guidelines that advocate for the reduction of unnecessary antibiotic usage in children with upper respiratory illnesses. The AAP joins other organizations that are in the process of identifying unnecessary or overused medical tests or procedures as part of the Choosing Wisely campaign. Learn more about the Choosing Wisely initiative at

A clinical report from the American Academy of Pediatrics (AAP), in collaboration with the Centers for Disease Control and Prevention (CDC), offers updated guidance on treating upper respiratory tract infections (URIs) in children, with the goal of reducing unnecessary antibiotics prescriptions.

The clinical report advises physicians to use stringent diagnostic criteria to distinguish between viral and bacterial infections. The report focuses on 3 of the most common pediatric URIs: ear infections, sinus infections, and strep throat.

The report is particularly timely as we enter the winter season, when many respiratory viruses commonly circulate. The AAP hopes that these principles will help physicians to more appropriately diagnose and treat otitis media, sinusitis, and strep pharyngitis.

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 2 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 November 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 required.

  1. Hersh AL, Jackson MA, Hicks LA; Committee on Infectious Disease. Principles of judicious antibiotic prescribing for bacterial upper respiratory tract infections in pediatrics. Pediatrics. 2013. Epub ahead of print. November 18, 2013. Available at: Accessed November 22, 2013.

Topics: Hayes Blog

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