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Section 4. Antimicrobial Agents and Related Therapy
APPROPRIATE USE OF ANTIMICROBIAL AGENTS
Principles of Appropriate Use for Upper Respiratory Tract Infections
Approximately three fourths of all outpatient prescriptions for children are given for 5 conditions: otitis media, sinusitis, cough illness/bronchitis, pharyngitis, and nonspecific upper respiratory tract infection (the common cold). Physicians report that many patients and parents try to persuade them to dispense unnecessary antimicrobial agents. Children treated with an antimicrobial agent are at increased risk of becoming carriers of resistant bacteria, including S pneumoniae and Haemophilus influenzae. Carriers of a resistant strain who develop illness from that strain are more likely to have antimicrobial therapy failure. In some conditions, such as otitis media with effusion, observation without antimicrobial therapy is recommended, and in other conditions such as the common cold or cough, antimicrobial therapy is not indicated. The following principles, with detailed supporting evidence, were published by the American Academy of Pediatrics, American Academy of Family Physicians, and Centers for Disease Control and Prevention (CDC) to identify clinical conditions for which antimicrobial therapy could be curtailed without compromising patient care. 1
Otitis Media
Episodes of otitis media should be classified as acute otitis media (AOM) or otitis media
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