American Academy of Pediatrics

View all recommendations from this society

Released February 21, 2013; updated July 13, 2016 and June 12, 2018

Antibiotics should not be used for viral respiratory illnesses (sinusitis, pharyngitis, bronchitis and bronchiolitis).

Antibiotics should not be used for upper respiratory illnesses characterized by congestion, cough, or pharyngeal pain unless criteria for bacterial sinusitis or Group A streptococcal pharyngitis are met. The vast majority of these infections are caused by viruses.


Respiratory infections account for the majority of antibiotic prescriptions for children, and it is estimated that 50% of antibiotic prescriptions for respiratory infections in children are unnecessary. Antibiotic use for viral respiratory illnesses not only leads to higher healthcare costs and more adverse events, but also can lead to antibiotic resistance.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatrics (AAP) employed a three-stage process to develop its list. Using the Academy’s varied online, print and social media communication vehicles, the first stage invited leadership of the Academy’s 88 national clinical and health policy-driven committees, councils and sections to submit potential topics via an online survey. The second stage involved expert review and evaluation of the management groups that oversee the functions of the committees, councils and sections. Based on a set of criteria (evidence to document unproven clinical benefit, potential to cause harm, over-prescribed and utilized, and within the purview of pediatrics) a list of more than 100 topics was narrowed down to five. Finally, the list was reviewed and approved by the Academy’s Board of Directors and Executive Committee.

AAP’s disclosure and conflict of interest policy can be found at


Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST.  Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years.  Pediatrics. Jul 2013;132(1):e262-80

Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles III S, Hernandez-Cancio S.  Clinical practice guideline for the diagnosis, management, and prevention of bronchiolitis.  Pediatrics. Nov 2014;134(5):e1474-502.

Fleming-Dutra KE, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016; 1864-73.

American Academy of Pediatrics. Antimicrobial resistance and antimicrobial stewardship: appropriate and judicious use of antimicrobial agents.  In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2018:906-913-880.