Upper Respiratory Tract Infections

Every day worried parents bring their children to clinicians for evaluation of coughs, runny noses, and sore throats. Most of these children have a simple cold and only require reassurance. However, clinicians must remain vigilant to not overlook a more severe possibility, such as secondary bacterial infection, an asthma exacerbation, or perhaps a foreign body. After ruling out a more severe issue, the most likely possibility is an everyday viral infection. These upper respiratory tract infections (URIs) and pharyngeal infections have many causes, but their presentations tend to follow similar patterns, which allow clinicians to reassure and advise worried parents.

On average, children are infected with two to eight URIs annually in the first 2 years after birth; those who attend day care may have as many as 14 annually. Even older children and adults may experience three to six URIs a year. In the United States, infants in the first year after birth experience an estimated 12 to 32 million URIs annually, and older children as many as 200 million. These viral illnesses result in millions of office visits and more than 10 million antibiotic prescriptions every year. The risk of secondary bacterial infections with URIs has been estimated at 0.5% up to as high as 5% to 10% for acute bacterial sinusitis. For acute otitis media, the estimated risk is up to 36% in infants younger than 1 year of age, decreasing to 15% for children 2 to 3 years old.

Unfortunately, for the more than 2 million cases of acute bronchitis diagnosed annually in children, approximately 70% result in a prescription for an antibiotic, despite the lack of any …