Abstract
“Clinical practice guideline for acute otitis media in children” was issued in 2006 and revised in 2009 as an original guideline for pediatric patients in Japan under circumstances of the increase in the prevalence of drug-resistant pathogens. Amoxicillin is recommended as the first-line antibiotics and not to be prescribed to mild cases for their first 3 days in the guideline. One of the most important aims of this guideline would be to spread the appropriate use of antibiotics. To achieve this aim, the same strategy as the guideline could be applied for the management of other upper respiratory tract infections, such as acute rhinosinusitis and acute pharyngo-tonsillitis.
Differentiation of bacterial infections from viral ones is the essential to make a decision of antibiotic-use. It is made mostly by rapid antigen detection testing in cases of pharyngo-tonsillitis. One has to remember exudates observed on the surface of tonsills do not always mean bacterial infections. Long lasting (≥10 days in most cases) purulent rhinorrhea is the only reliable clinical indicator for the diagnosis of bacterial acute rhinosinusitis. Although there are some controversies, amoxicillin is still recommended as the first-line antibiotic for both pathological situations.
