Remember to check allergy status


Paediatric Treatment - Upper Respiratory Tract Infections


Acute Sore Throat


Avoid antibiotics as 90% resolve in 7 days without1 A+, and pain only reduced by 16 hours 2 A+.

Use FeverPAIN Score: Fever in last 24h, Purulence, Attend rapidly under 3 days, severely Inflamed tonsils, No cough or coryza.3 B+ 4 B+

Score 0-1: 13-18% streptococci, use NO antibiotic strategy
Score 2-3: 34-40% streptococci, use 3 day back-up antibioitc
Score 4 or more: 62-65% streptococci, use immediate antibiotic if severe, or 48hr short back-up prescription.5 A-

Always share self-care advice and safety net.

Antibiotics to prevent Quinsy NNT >4000 4 B-
Antibiotics to prevent Otitis media NNT 200 2 A+
RCT in <18yr olds shows 10d penicillin had lower relapse vs 7d 8

Medicine Calendar

phenoxymethylpenicillin 5 B-

See BNFc

10 days 8A-

** If Penicillin Allergic**

See BNFc

5 days 9 A+

Acute otitis media

NICE-Fever in children

Optimise analgesia and target antibiotics 2,3B- AOM resolves in 60% in 24hrs without antibiotics, which only reduce pain at 2 days (NNT15) and does not prevent deafness 4 A+

Consider 2 or 3-day delayed antibiotics1 A+, or immediate antibiotics for pain relief if: <2 years AND bilateral AOM (NNT4) or bulging membrane and have 4 or more marked symptoms 5-7A+

All ages with otorrhoea NNT3 8 A+
Abx to prevent Mastoiditis NNT >4000 9 B-

Medicine Calendar

amoxicillin 10 A+

Neonate 7-28 days 30mg/kg TDS.
1 month-1 yr: 125mg TDS.
1-5 years: 250mg TDS.
5-18 years: 500mg TDS

5 days 13 A+

Penicillin Allergy:
erythromycin 11 D

< 2yrs: 125mg QDS
2-8yrs: 250mg QDS
8-18yrs: 250-500mg QDS

5 days 13 A+

Acute rhinosinusitis 5C


Avoid antibiotics as 80% resolve in 14 days without; and they only offer marginal benefit after 7 days NNT15 2,3 A+

Use adequate analgesia 4 B+ Consider 7-day delayed or immediate antibiotic when purulent nasal discharge NNT8 1,2 A+

In persistent infection use an agent with anti- anaerobic activity e.g. co-amoxiclav 6 B+

Medicine Calendar

amoxicillin 4 A+,7 A

See BNFc

7 days 9 A+

phenoxymethylpenicillin 8 B+

See BNFc

7 days

For persistent symptoms:
co-amoxiclav 6 B+

See BNFc

7 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).