Recurrent Upper Respiratory Tract Infections


In pediatric praxis, upper respiratory tract infections (URTI) are the most common reason for medical consultation. Both otitis media as well as pharyngitis/tonsillitis are key contributors to high antibiotic use in children. Nevertheless, the problem of recurrent infections remains. 

Sore throat and pharyngitis/tonsillitis represent a painful inflammation of the pharyngeal mucosa, is often the accompanying symptom of the common cold and can be associated with fever. Pharyngitis and tonsillitis are often caused by bacteria (e.g., β-haemolytic streptococci) and typically characterized by symptoms such as fever, sore throat and swallowing pain. Patients suffering from severe symptoms should consult with a physician. In many cases pharyngitis/tonsillitis arises out of a viral infection of the throat area which provides the environment for bacteria to grow, known as bacterial super infection. 

The most common bacterial cause for pharyngitis and tonsillitis are group A Streptococcus (Streptococcus pyogenes).

Otitis media

Acute otitis media is one of the most common URTI in young children and two third of all children became in touch with an Otitis media infection in their first three years of life. Recurrent episodes of Otitis media infections are very common in infants and children under 5 years of age. Due to high prevalence in children, it leads into one of the main causes for antibiotic treatment in children up to three years. Typical symptoms of Otitis media include ear pain, fever, cough, nasal discharge and irritability. The most common bacteria associated with Otitis media are Streptococcus pneumoniae and Haemophilus influenza followed by Streptococcus pyogenes, Staphylococcus aureus and Moraxella catarrhalis. Those pathogens originate from the nasopharynx and are invading the middle ear via the Eustachian tube.

Antibiotic therapy

In case a respiratory tract infection is bacteria related, the standard treatment is an antibiotic therapy. However, in addition to the various side effects of antibiotics such as nausea, cramps and diarrhea, drugs resistant bacteria strains are becoming more and more a challenge for the treatment of bacteria induced URTI. Consequently, a multinational surveillance study showed that the percentage of multidrug resistant (MDR) Streptococcus pneumoniae and beta-Lactamase-producing Haemophillus influenza or Moraxella catarrhalis, group A β-haemolytic streptococci strains reached in some countries 25% of all identified strains.2 Antibiotic resistance in S. pneumoniae and S. pyogenes remains a significant problem worldwide.