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Paediatr Respir Rev. 2014 Sep;15(3):231-6. doi: 10.1016/j.prrv.2013.11.011. Epub 2013 Dec 8.

Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics.

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Department of Health Sciences, Paediatric Section, Anna Meyer Children's University Hospital, Florence, Italy.
Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples.
Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Second University of Naples, Naples, Italy.
Primary care Pediatrician, Milan, Italy.
Health Search Institute, Italian College of General Practitioners, Florence, Italy.
President Italian Society of Preventive and Social Pediatrics Primary care Pediatrician, Caserta, Italy.
Department of Pathophysiology and Transplantation, Pediatric Clinic 1, Università degli Studi di Milano, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
Department of Pediatrics, University of Bari Aldo Moro, Bari, Italy.
Epidemiology Unit, AUSL Naples 1, Italy.



Several guidelines for the management of respiratory tract infections in children are available in Italy, as well as in other European countries and the United States of America. However, poor adherence to guidelines and the sustained inappropriate use of antibiotics have been reported. In the outpatient setting, almost half of antibiotics are prescribed for the treatment of common respiratory tract infections. In Italy the antibiotic prescription rate is significantly higher than in other European countries, such as Denmark or the Netherlands, and also the levels of antibiotic resistance for a large variety of bacteria are higher. Therefore, the Italian Society of Preventive and Social Paediatrics organised a consensus conference for the treatment of respiratory tract infections in children to produce a brief, easily readable, evidence-based document.


The conference method was used, according to the National Institute of Health and the National Plan Guidelines. A literature search was performed focusing on the current guidelines for the treatment of airway infections in children aged 1 month-18 years in the ambulatory setting.


Recommendations for the treatment of acute pharyngitis, acute otitis media, sinusitis, and pneumonia have been summarized. Conditions for which antibiotic treatment should not be routinely prescribed have been highlighted.


This evidence-based document is intended to accessible to primary care pediatricians and general practice physicians in order to make clinical practice uniform, in accordance with the recommendations of the current guidelines.


Antibiotics; Children; Guidelines; Respiratory tract infections

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