Optimizing the management of the main acute infections in pediatric ORL: tonsillitis, sinusitis, otitis media.
Sinusitis, acute otitis media and tonsillitis are very frequent in children. Most of these infections are caused by viruses, but are generally treated with antibiotics. Inappropriate use of antibiotics favors the selection, growth and spread of resistant bacteria; these bacteria colonize the airways and affect the entire community. With the emergence of antibiotic-resistant bacteria, respiratory infections have become more difficult to treat. Effective strategies are needed to restrict the use of antibiotics without harming children that truly need these drugs.


OBJECTIVE
to present a critical analysis of the results of randomized and controlled studies on clinical and laboratory criteria used in diagnosing and treating tonsillitis, sinusitis and otitis.


METHODS
a review of randomized and controlled studies about these conditions published in MEDLINE and SCIELO from 2000 to 2006.


CONCLUSIONS
Given that most of these infections progress favorably without antibiotics, the use of these drugs should be avoided unless the child belongs to a high risk group for complications, or symptoms persist or worsen with despite symptomatic treatment. Physicians and laypersons should have better knowledge about the natural evolution of acute respiratory infections.
Sih
Tania Maria
TM
Adjunct professor, Laboratório de Investigações Médicas (LIM), number 40, Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Bricks
Lucia Ferro
LF
Adjunct professor, Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo (FMUSP).
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D004352:Drug Resistance, Microbial; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000628:therapy; D012852:Sinusitis / Q000175:diagnosis / Q000628:therapy*; D014069:Tonsillitis / Q000175:diagnosis / Q000628:therapy*
D000900:Anti-Bacterial Agents