Antibiotics for Children With Upper Respiratory Tract Infections—Reply

In Reply.—These letters raise several important issues: Is there a benefit of antibiotic therapy for children with cough or colds (nasopharyngitis)? Are antimicrobial use practices of family physicians really different from those of pediatricians and, if so, why? Dr Chen suggests that nasopharyngitis, bronchitis, and URIs may not be viral in etiology. Although some misclassification may occur in the diagnosis of the common cold, a recent study of 200 young adults in Finland who had rhinorrhea, congestion, or sore throat identified a viral etiology in 138 (69%) and a bacterial etiology in 7 (3.5%). Among the latter group, 4 patients had evidence of infection with C pneumoniae, and 1 each had M pneumoniae, S pneumoniae, and nontypable Haemophilus influenzae.¹ Given the unclear benefit of antimicrobial therapy for C pneumoniae infections, the potential benefit of treating these colds would have been minimal. Clinical trials comparing outcome in patients with colds and bronchitis who received antimicrobial therapy or placebo confirm the lack of substantial treatment effect.^2- 3