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Section 4. Antimicrobial Agents and Related Therapy
Appropriate and Judicious Use of Antimicrobial Agents
Principles of Appropriate Use for Upper Respiratory Tract Infections
Approximately three quarters of all outpatient prescriptions of antimicrobial agents for children are given for 5 conditions: otitis media, sinusitis, cough illness/bronchitis, pharyngitis, and nonspecific upper respiratory tract infection (the common cold). Antimicrobial agents are prescribed, even though many of these illnesses are caused by viruses and are unresponsive to antimicrobial therapy. 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 failure of antimicrobial therapy. In some conditions, such as otitis media with effusion (OME), 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
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