Current issues in upper respiratory tract infections in infants and children: rationale for antibacterial therapy.

Otitis media is a common infection in preschool-age children, but selected children have recurrent and severe disease. The characteristics of these children include a first episode of infection at an early age, sibling(s) with a history of ear infections, a history of not having been breast-fed, attending group day care and living in a household with exposure to cigarette smoke. The organisms responsible for otitis media are consistently the pneumococcus, H. influenzae and, in some areas, M. catarrhalis. Changes in antimicrobial susceptibility and differences in virulence govern the choice of antimicrobial agents. Although many drugs have clinical efficacy in children with AOM, the choice of optimal agents should be based on knowledge of microbiologic efficacy against the major pathogens, dosage schedules, side effects, palatability and cost. Sinusitis shares with otitis media similar pathogenesis, microbiology and choices of antimicrobial drugs for treatment. Although there are fewer data on epidemiology and microbiologic efficacy available for sinusitis than for otitis media, antibiotics are important for the clinical improvement and eradication of the bacterial pathogen from the infected sinus. Group A streptococcal infections are an increasing cause of concern because of reports of outbreaks of rheumatic fever in some cities in the United States and fatal or severe invasive infections and toxin-associated disease. Although Group A streptococci remain susceptible to penicillins and cephalosporins, higher rates of eradication of the organism from the pharynx by cephalosporins or by macrolides compared with penicillin have raised doubt as to the continued consideration of penicillin as the drug or choice for patients with streptococcal pharyngitis in communities with high incidence of supperative or nonsupperative disease.