Pediatric Outpatient Treatment Recommendations
Antibiotic prescribing guidelines establish standards of care, focus quality improvement efforts, and improve patient outcomes. The table below summarizes the most recent principles of appropriate antibiotic prescribing for children obtaining care in an outpatient setting for the following six diagnoses: acute rhinosinusitis, acute otitis media, bronchiolitis, pharyngitis, common cold, and urinary tract infection.
|Acute sinusitis1, 2||Sinusitis may be caused by viruses or bacteria, and antibiotics are not guaranteed to help even if the causative agent is bacterial.||Halitosis, fatigue, headache, decreased appetite, but most physical exam findings are non-specific and do not distinguish bacterial from viral causes.
A bacterial diagnosis may be established based on the presence of one of the following criteria:
Imaging tests are no longer recommended for uncomplicated cases.
|If a bacterial infection is established:
|Acute otitis media (AOM)3-5||
||Definitive diagnosis requires either
AOM should not be diagnosed in children without middle ear effusion (based on pneumatic otoscopy and/or tympanometry).
|Common cold or non-specific upper respiratory tract infection (URI) 4,7||
|Urinary tract infections (UTIs)8, 9||
- Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 yearsexternal icon. Pediatrics. 2013;132(1):e262-80.
Available at: http://pediatrics.aappublications.org/content/early/2013/06/19/peds.2013-1071external icon
- Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adultsexternal icon. Clin Infect Dis. 2012;54(8):e72-e112.
Available at: https://academic.oup.com/cid/article/54/8/1041/364141/Executive-Summary-IDSA-Clinical-Practice-Guidelineexternal icon
- Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis mediaexternal icon. Pediatrics. 2013;131(3):e964-99.
Available at: http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-3488external icon
- Hersh AL, Jackson MA, Hicks LA, et al. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatricsexternal icon. Pediatrics. 2013;132(6):1146-54.
Available at: http://pediatrics.aappublications.org/content/132/6/1146?rss=1external icon
- Coker TR, Chan LS, Newberry SJ, et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: A systematic reviewexternal icon. JAMA. 2010;304(19):2161-9.
Available at: http://jamanetwork.com/journals/jama/fullarticle/186896external icon
- Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of Americaexternal icon. Clin Infect Dis. 2012;55(10):e86–102.
Available at: https://academic.oup.com/cid/article/55/10/e86/321183/Clinical-Practice-Guideline-for-the-Diagnosis-andexternal icon
- Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adultsexternal icon. Am Fam Physician. 2012;86(2):153-9.
Available at: http://www.aafp.org/afp/2012/0715/p153.htmlexternal icon
- Ralston SL, Lieberthal AS, Meissner HC, et al. American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitisexternal icon. Pediatrics. 2014 Nov;134(5):e1474-502.
Available at: http://pediatrics.aappublications.org/content/134/5/e1474.longexternal icon
- Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 monthsexternal icon. Pediatrics. 2011;128(3):595–610.
Available at: http://pediatrics.aappublications.org/content/early/2011/08/24/peds.2011-1330external icon
- White B. Diagnosis and treatment of urinary tract infections in childrenexternal icon. Am Fam Physician. 2011;83(4):409-15.
Available at: http://www.aafp.org/afp/2011/0215/p409.htmlexternal icon