Antibiotics for Acute Respiratory Tract Infections: Now, Later, or Never?

Abstract

* Abbreviations: ARTI — : acute respiratory tract infection AOM — : acute otitis media On average, children in the United States receive more than 1 antibiotic prescription per year, driven largely by acute respiratory tract infections (ARTIs).1,2 Although most ARTIs are caused by viruses, some are bacterial infections, a subset of which benefit from antibiotics. Identifying the ARTIs that need antibiotics is not always easy. Primary care, urgent care, and emergency medicine clinicians have a hard job. To address this challenge, the Centers for Disease Control and Prevention outlines multiple approaches to outpatient antibiotic stewardship,3 including delayed antibiotic prescribing, in which a provisional antibiotic prescription is given to a patient or caregiver to fill if symptoms persist or worsen. An example of this approach is acute otitis media (AOM), in which delayed prescribing has been shown to safely reduce antibiotic exposure.4 In this issue of Pediatrics , Mas-Dalmau et al5 report findings from a multicenter, randomized controlled clinical trial comparing antibiotic prescribing strategies for ARTIs in children from 2 to 14 years old presenting to 1 of 39 primary care clinics in Spain. Overall, 436 subjects with AOM, … Address correspondence to Jeffrey S. Gerber, MD, PhD, Division of Infectious Diseases, Children’s Hospital of Philadelphia, 2716 South St, Room 10364, Philadelphia, PA 19146. E-mail: gerberj{at}chop.edu