Table 1

Diagnostic criteria for bacterial acute respiratory tract infections (ARTIs) and appropriate antibiotic selection

Bacterial ARTIDiagnostic criteriaPrimary antibioticSecondary antibiotics for penicillin allergy
Acute Otitis Media
(either criteria)

  1. Fever ≥38.3°C with either A or B:

    1. Moderate to severe bulging of tympanic membrane on exam, or

    2. Mild bulging of TM and recent (<48 hours) onset of ear pain

  2. New onset of otorrhea not due to acute otitis externa

AmoxicillinCefdinir, cefpodoxime, ceftriaxone, cefuroxime, clindamycin
Sinusitis
(any of the three criteria)

  1. Daytime cough or nasal discharge for greater than 10 days

  2. High fever (>39°C) with purulent nasal discharge or facial pain lasting three consecutive days at the beginning of the illness

  3. Worsening signs or symptoms characterised by the new onset of fever, headache, or increase in nasal discharge following a typical viral URI

AmoxicillinCefdinir, cefpodoxime, cefuroxime, clindamycin
Community acquired Pneumonia
(either criteria)

  1. Fever, tachypnoea and focal findings on pulmonary exam

  2. (A) Fever, (B) Tachypnoea, cough or retractions and (C) chest radiograph consistent with a focal consolidation

AmoxicillinCefpodoxime, cefprozil, cefuroxime, clindamycin
Streptococcal pharyngitis
(both criteria)

  1. Fever, pharyngitis and positive rapid streptococcal antigen test or culture

  2. Lack of viral signs and symptoms

AmoxicillinCephalexin (preferred unless previous type I hypersensitivity reaction to penicillin) clindamycin, azithromycin

  • TM, tympanic membrane; URI, upper respiratory infection.