Management of Upper Respiratory Tract Infections

(URTIs) in Pediatrics

Version 1 – June 2024

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 Table of Contents

Content Page
Purpose and Scope 3
Acknowledgement 3
Policy Statement 4
Definitions 4
Abbreviations 6
Background 6
Procedure and Responsibilities 7
References 11
Tools and Attachments 18
Key Performance Indicators 18
Attachment 1: Risk Factors for Severe Influenza in Pediatrics 19
Attachment 2: Recommended Doses for Oseltamivir in Pediatrics 19
Attachment 3: Attachment 3: Microbiology of Respiratory Tract Infections in Pediatrics 20
Attachment 4: Centor Criteria 21
Attachment 5: Recommended Approach for Management of Suspected GAS Pharyngitis in 22
Pediatrics
Attachment 6: Recommended Antibiotic Regimen for GAS Pharyngitis in Pediatrics 23
Attachment 7: Recommended Empiric Antibiotic Regimen for Acute Bacterial Sinusitis in 24
Pediatrics
Attachment 8: Management of Acute Otitis Media in Pediatrics 25
Attachment 9: Empiric Antibiotics for Acute Otitis Media in Pediatrics 26
Attachment 10: Management of Acute Otitis Media in Pediatrics 27
Attachment 11: Westley Croup Severity Score 28
Attachment 12: Empiric Antibiotic Therapy for Acute Epiglottitis in Pediatrics 29
Attachment 13: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-positive 30
Antibiogram (UAE 2022)
Attachment 14: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-negative 31
Antibiogram (UAE 2022)

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 Purpose and Scope

1.1 This guideline is an initiative of the National Antimicrobial Stewardship Committee and has
been compiled by national multidisciplinary team across the UAE composed of (Pediatrics
infectious disease, ENT specialty, General pediatrics, clinical pharmacy and Microbiology
specialties).

1.2 This guideline was established to guide all health care professionals dealing with pediatrics
age group children (0-16 years) of age to aid on clinical diagnosis, management and treatment
of URTIs including (Viral URTIs, acute pharyngitis, acute otitis media, acute bacterial sinusitis,
laryngotracheobronchitis (croup) and epiglottitis.

1.3 The guideline takes in consideration the international standards on the treatment of the
above-mentioned diagnosis as well as the local national antibiogram reports and therefore
will be subject to revisions and modifications every 3 years.

2. Acknowledgement:

This document was developed by; National URTI (Pediatric) guidelines Taskforce, under
National Antimicrobial Resistance committee.
1. Dr. Huda Sulaiman Aldhanhani
2. Dr. Maysa Saleh
3. Dr. Aisha Abdala Alkhaaldi
4. Dr. Dr. Zulfa Omar Deesi
5. Dr. Sally Tayseer Altaher
6. Dr. Nader Francis
7. Dr. Ayesha Abdulla Al Marzooqi
Reviewed by:
1. Dr Nehad Al Shirawi, Chair of National ASP Committee ICU Consultant ICU, Al Fujairah
Hospital, EHS.
2. Dr Walid Mohammad Abuhammour, Consultant Infectious Diseases, Al Jalila Children’s
Hospital
Published by: Ministry of Health and Prevention UAE, in electronic format only.

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 3. Policy Statement

3.1 These guidelines are intended to provide guidance for healthcare professionals working in
the hospital or outpatient settings on the optimal management of children with suspected
and confirmed URTI (Viral URTIs, acute pharyngitis, acute otitis media, acute bacterial
sinusitis, laryngotracheobronchitis (croup) and epiglottitis).

3.2 The National Antimicrobial Stewardship Committee strongly recommends either adopting
this guideline or developing/amending a facility-based guideline using this document as a
reference tool.

4. Definitions

4.1 Acute Bacterial Rhinosinusitis (ABS): is an infection of the paranasal sinuses inducing
persistent or severe symptoms of nasal or postnasal drainage, daytime cough, headache,
facial pain, or some combination of these.

4.2 Acute Otitis Media (AOM): infection of the middle ear often associated with moderate to
severe bulging of the tympanic membrane or new onset of otorrhea.

4.3 Chronic Otitis Media (COM): when OME persists more 3 months.

4.4 Chronic Rhinosinusitis (CRS): The presence of 2 or more of the following cardinal symptoms
lasting for 12 weeks or longer: nasal obstruction, nasal discharge (anterior or posterior), facial
pain/pressure, and cough.

4.5 Common Cold: is an acute, self-limited viral infection of the upper airway that may also
involve the lower respiratory tract which is mostly caused by viral illness such as Respiratory
syncytial virus (RSV), human metapneumovirus, parainfluenza viruses (PIVs), human
coronaviruses (HCoVs), rhinoviruses, adenoviruses, influenza viruses, and enteroviruses and
SARS-Cov2 etc.

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4.6 Epiglottitis: is a life-threatening condition caused by inflammation of the epiglottis and
adjacent supraglottic structures, primarily due to infection but can be due to other causes.

4.7 Influenza: infection is caused by one of the influenza viruses such as influenza A and B and
less frequently influenza C, younger children and school aged children have higher rate of
infection and may be a source of infection to adults in households.

4.8 Laryngitis: refers to inflammation limited to the larynx and manifests itself as hoarseness. It
usually occurs in older children and adults.

4.9 Laryngotracheitis (Croup): A respiratory illness characterized by inspiratory stridor, barking

cough, and hoarseness.

4.10 Laryngotracheobronchitis: occurs when inflammation extends into the bronchi, resulting
in lower airway signs.

4.11 Otitis media with effusion (OME): the presence of fluid in the middle ear with
accompanying conductive hearing loss and without concomitant symptoms or signs of ear
infection.

4.12 Otitis-conjunctivitis: (also called conjunctivitis-Otitis syndrome) defined as the presence

of purulent conjunctivitis in association with AOM.

4.13 Pharyngitis: is an inflammation of the mucous membranes and underlying structures of

the throat and acute pharyngitis is defined as an infection of the pharynx and/or tonsils.

4.14 Rhinosinusitis: is an inflammation of the nose and paranasal sinuses.

4.15 Subacute OME: when OME persists from 3 weeks to 3 months after the onset of AOM.

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5. Abbreviations

AAP: American Academy of Pediatrics.

ABRS: Acute Bacterial Rhinosinusitis.
AMR: Antimicrobial Resistance.
AMR: Antimicrobial resistance.
AOM: Acute Otitis Media.
ARI: Acute Respiratory Infection.
ARS: Acute Rhinosinusitis.
CT: Computed Tomography.
GAS: Group A Streptococcus.
HCoV: Human Coronavirus.
HEV: Human Enteroviruses.
HIB: Haemophilus influenzae type B.
hMPV: Human Metapneumovirus.
HPIV: Human Parainfluenza.
HRV: Human Rhinovirus.
IDSA: Infectious Disease Society of America.
RADT: Rapid Antigen Detection Test.
UAE: United Arab Emirates.
URTI: Upper Respiratory Tract Infection.
WBC: White blood cell.

6. Background

6.1 Upper respiratory tract infections (URTIs) are among the most prevalent diagnoses across all
age groups especially in outpatient settings. URTIs are commonly caused by viral infections,
symptoms are variable; can range from mild nasal symptoms to serious conditions like
epiglottitis. In most situations, supportive symptomatic management is sufficient.

6.2 Most URTIs are viral in origin with differences in prevalence and seasonality, influenza virus
often contributes to the winter peak, but Rhinovirus (HRV) present year-round with no
significant seasonality. Although epidemiological features of respiratory viral infections in
UAE is scarce, acute respiratory infections contributed to 13.6% in pediatric age group.

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 Furthermore, bacterial infections may cause acute tonsillopharyngitis in children and
adolescents. Most commonly, Streptococcus pyogenes (Group A streptococcus, GAS) which
accounts for approximately 15%- 30 % of all cases of pharyngitis in children.

7. Procedure and Responsibilities

Procedure Responsibilities
6.1 Management of Common Cold Physician

• As the cause is mainly viral, confirmation of the specific virus is not recommended
except in case of hospitalization for “cohorting” patients and for epidemiologic
studies.
• Common cold is a self-limiting illness. Management is mainly supportive.
• Anti-virals are not recommended.
• Antibiotics have no role.
6.2 Management of Influenza Physician

• Risk factors for severe influenza in children are listed in attachment 1.

• Test for influenza during the season of influenza or if there is a clear history of
exposure to a known diagnosed case with influenza.

• The gold standard test is real time PCR.

• Influenza rapid antigen test is simple, quick (results in < 60 minutes) and inexpensive
test.
• Empiric treatment with antivirals indications: Start Oseltamivir within 24-48 hours of
illness, don’t wait for confirmatory test in the below conditions:
- Severe presentation.
- Suspected or confirmed influenza requiring hospitalization and for persons with
progressive or complicated illness, regardless of previous health or vaccination
status.
- High risk persons such as children with underlying medical condition and young
children below 5 years of age

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 • Recommendation for Oseltamivir dose in pediatrics is listed in attachment 2.
6.3 Diagnosis of Acute Pharyngitis Physician

• Microbiology of acute pharyngitis is outlined in attachment 3.

• No single or combination of physical findings is specific for distinguishing GAS from
viral etiologies, the IDSA has attempted to categorize some of the clinical
differentiators:
- Category 1 (probable viral pharyngitis) - Conjunctivitis, coryza, cough, diarrhea,
viral-like exanthema.
- Category 2 (suggestive of possible bacterial pharyngitis) - Fever of more than
38.5°C, tender cervical nodes, headache, petechiae of the palate, abdominal
pains, or sudden onset (< 12 h).
• Modified Centor Score can be used to support the suspicion for GAS infection;
however, it should not be used alone. (See Attachment 4)
• Indications for testing for GAS: Clinical decision rules, such as Centor Score, can
assist in identifying patients with higher risk for GAS who warrant testing. For
children with a high pre-test probability of having GAS pharyngitis (e.g., a Centor
Score ≥3), microbiological diagnosis is important to limit inappropriate antibiotic
use.
• Supportive approach is recommended in cases of viral pharyngitis.
• GAS is often susceptible to penicillin and according to the UAE AMR report of 2020
there was no detection of penicillin resistance GAS strains (See attachment 13)
• Antibiotic treatment of GAS pharyngitis has been shown to prevent suppurative
complications and ARF, but not post-streptococcal glomerulonephritis.
• Recommendations for treatment of proven or highly suspected bacterial etiology for
pharyngitis/tonsillitis (GAS infection) are outline in attachment 5.

• Recommended antibiotic treatment regimen for GAS pharyngitis is outline in

attachment 6.
6.4 Management of Acute Bacterial sinusitis (ABS) Physician

• Microbiology of acute bacterial sinusitis is outlined in attachment 3.

• ABS is purely a clinical diagnosis; criteria that can be used:
- Worsening course (double sickening): worsening or new onset of nasal
discharge, daytime cough, or fever after initial improvement; OR

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 - Severe onset: concurrent fever (temperature ≥39°C) and purulent nasal
discharge for at least 3 consecutive days.
- Persistent illness: nasal discharge (of any quality) or daytime cough or both lasting
more than 10 days without improvement.
• Watchful waiting (conservative approach) is recommended for mild cases of acute
rhinosinusitis with symptomatic relief: saline nasal sprays, humidifiers, and over-the-
counter analgesics (e.g., acetaminophen or ibuprofen). Furthermore, if the patient
meets the above criteria of ABS antibiotics treatment should be started once the
diagnosis is established
• Antibiotics Therapy:
- Uncomplicated ABS, non-toxic appearing and can ensure follow-up in 72 hrs.:
standard dose of empirical amoxicillin-clavulanate.
- Severe symptoms or follow up within 72 hours is not permitted: high-dose of
empirical oral amoxicillin-clavulanate
- Second line Antibiotics: If the patient meets one of the below risk factors for
streptococcus pneumonia: antimicrobial resistance, consider 2nd line treatment
options
o Age less than 2 years.
o Residing in an area with a high endemic rate (≥10%) of Ampicillin-resistant H.
influenzae and Penicillin-non-susceptible S. pneumonia.
o Received antimicrobial treatment within the past month.
o Recent hospitalization.
o Daycare attendance.
o Un-immunization or partial immunization with pneumococcal conjugate
vaccine.
o Immunodeficiency.
• Recommended duration of antibiotics: 10-14 days or 7 days after symptoms
improvement.
• Indication for hospitalization for intravenous antimicrobials therapy:

-
Severe ABS
-
Complications
-
Treatment failure with outpatient therapy after a second course of oral
antimicrobials
• Recommended antibiotics for ABS are outlined in attachment 7.
6.5 Management of Chronic Rhinosinusitis (CRS): Physician

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 • Oral antibiotics are the mainstay of treatment of CRS in children along with control
of the inflammation.
• First-line: high-dose amoxicillin or amoxicillin-clavulanic acid, Duration of
treatment: 21 days
• Second-line (penicillin allergy): Cephalosporins (second or third generations) for at
least 3 weeks.
6.6 Management of Acute Otitis Media: Physician

• Microbiology of acute otitis media is outlined in attachment 3.

• The choice of strategy (start antibiotics or observe) depends upon the severity of
illness, the age of the child, associated conditions, and caregiver preference and
reliability. (See attachment 8)
• Children at increased risk of severe infection, complications, and/or recurrent
include:
- Infants <6 months of age.
- Immunocompromised.
- Patients who are toxic appearing.
- Patients with craniofacial abnormalities (eg, cleft palate).
• Empiric Antibiotics for AOM are listed in attachment 9 and 10.
6.7 Management of Croup: Physician

• There are a number of validated clinical scoring systems that are used to assess
croup severity. The Westley croup score has been the most extensively used to
assess croup clinical severity. See attachment 11.
• Management of croup is basically supportive and no antibiotics are indicated.
6.8 Management of Acute Epiglottitis: Physician

• Recommended empiric antibiotics for acute epiglottitis are outlined in attachment

12.
6.9 Attachments 13 and 14 illustrates Cumulative Antimicrobial Susceptibility Pediatric Age, Physician
Antibiogram (UAE 2022).

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17
9. Tools and Attachments:

9.1 Attachment 1: Risk Factors for Severe Influenza in Pediatrics.

9.2 Attachment 2: Recommended Doses for Oseltamivir in Pediatrics.
9.3 Attachment 3: Microbiology of Respiratory Tract Infections in Pediatrics.
9.4 Attachment 4: Centor Criteria.
9.5 Attachment 5: Recommended Approach for Management of Suspected GAS Pharyngitis in
Pediatrics.
9.6 Attachment 6: Recommended Antibiotic Regimen for GAS Pharyngitis in Pediatrics.
9.7 Attachment 7: Recommended Empiric Antibiotic Regimen for Acute Bacterial Sinusitis in
Pediatrics.
9.8 Attachment 8: Management of Acute Otitis Media in Pediatrics.
9.9 Attachment 9: Empiric Antibiotics for Acute Otitis Media in Pediatrics.
9.10 Attachment 10: Management of Acute Otitis Media in Pediatrics.
9.11 Attachment 11: Westley Croup Severity Score.
9.12 Attachment 12: Empiric Antibiotic Therapy for Acute Epiglottitis in Pediatrics.
9.13 Attachment 13: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-positive
Antibiogram (UAE 2022).
9.14 Attachment 14: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-negative
Antibiogram (UAE 2022).

10. Key Performance Indicators

10.1 Appropriate selection of antibiotic for upper respiratory tract infection in paediatric
(AOM).

10.2 Proper antibiotics prescription for GAS pharyngitis.

18
 Attachment 1: Risk Factors for Severe Influenza in Pediatrics

Children below < 5 years of age, particularly children <2 years

Children with underlying morbidities (Chronic asthma, cardiovascular, renal, hepatic, hematologic,
neurologic, neuromuscular or metabolic
Immune suppression due to medications or HIV infection
Children receiving long term aspirin therapy
Morbid obesity
Children below < 5 years of age, particularly children <2 years

Attachment 2: Recommended Doses for Oseltamivir in Pediatrics

Agent weight
Oseltamivir for 5 days 2 weeks – 11months 3mg/kg/dose twice a day
< and = 15 kg 30mg twice a day
>15 – 23 kg 45mg twice a day
>23-40kg 60mg twice a day
>40kg 75mg twice a day

*Dose need to be adjusted in children with renal failure

Note: Oseltamivir is approved for treatment of infants 2 weeks of age and chemoprophylaxis
for children 1 year of age, inhaled zanamivir is approved for treatment of children 7 years
and chemoprophylaxis for children 5 years of age

19
 Attachment 3: Microbiology of Respiratory Tract Infections in Pediatrics
Disease Organisms
Acute Pharyngitis • Viral infection is the most common etiology.
• Group A Streptococcus (GAS) accounts for almost 15 to 30 % of all cases of
pharyngitis in children between the ages of 5 and 15 years.
Acute Rhinosinusitis • Majority of cases are caused by viruses
• Bacterial causes include Streptococcus pneumoniae, Hemophilus influenzae,
and Moraxella catarrhalis.
• Hemophilus influenzae appears to have become more common, with increasing
rates of beta-lactamase production.
• According to the UAE antimicrobial resistance report of 2021, the prevalence of
Penicillin- resistant Streptococcus pneumonia to penicillin is only 7%.
Acute Otitis Media • Viral: respiratory syncytial virus (RSV), coronaviruses, influenza viruses,
adenoviruses, human metapneumovirus, and picornaviruses.
• Bacterial: Streptococcus pneumoniae, nontypeable Hemophilus influenzae
(NTHi), Moraxella catarrhalis, Group A Streptococcus (GAS) and uncommonly
Staphylococcus aureus.
Croup • Mainly viral infection, particularly parainfluenza viruses (1.2.3) influenza A,
influenza B, adenovirus, respiratory syncytial virus (RSV), and
metapneumovirus.
Epiglottitis • Bacteria: Haemophilus influenzae type b (Hib) primarily in unvaccinated or
incompletely immunized children which became less frequent after childhood
immunization.
• Other bacterial etiologies in immunocompetent individuals: Staphylococcus
aureus (including methicillin-resistant strains), Streptococcus pneumoniae,
Streptococcus pyogenes and other streptococci, Neisseria meningitidis, and
Pasteurella multocida.
• Pathogens that may cause epiglottis in immunocompromised hosts:
Pseudomonas aeruginosa, Serratia spp, Enterobacter spp, and anaerobic flora.
• Viral infection: may rarely cause epiglottitis or enable bacterial superinfection.
Viruses isolated include Influenza (A, B), Herpes simplex virus, types 1, 2,
Parainfluenza virus, Epstein-Barr virus, Human immunodeficiency virus (HIV),
SARS-CoV-

20
 Attachment 4: Centor Criteria

CENTOR Clinical decision rule

(Only for children aged 3 to 14 years)

]
One point for each characteristic:
• Exudate or swollen tonsils
• Tender or swollen anterior cervical lymph nodes
• Fever
• No cough

Note: Each of the Centor criteria score 1 point (maximum score of 4). A score of 0, 1 or 2 is thought
to be associated with a 3 to 17% likelihood of isolating streptococcus. A score of 3 or 4 is thought
to be associated with a 32 to 56% likelihood of isolating streptococcus.

21
Attachment 5: Recommended Approach for Management of Suspected GAS Pharyngitis

Adopted from: Canadian Family Physician April 2020, 66 (4) 251-257

22
 Attachment 6: Recommended Antibiotic Regimen for GAS Pharyngitis in Pediatrics

No history of Penicillin Allergy

Antibiotic Dose Duration
Penicillin V Children: 250 mg twice daily or 3 times daily 10 days
Route: oral Adolescents: 500 mg twice daily
Amoxicillin 50 mg/kg once daily (max = 1000 mg/day); 10 days
Route: oral alternative: 25 mg/kg (max = 500 mg) twice daily
Benzathine penicillin G Weight ≤ 27 kg: 600,000 units Once
Route: intramuscular Weight ≥ 27 kg: 600,000 units Once
(Consider IM penicillin G in
children who are not able to
tolerate oral antibiotics, who
may fail to complete the
course with difficulty to follow
up)
History of penicillin allergy
Cefalexin 20 mg/kg/dose twice daily (max = 500 mg/dose) 10 days
Route: Oral
Clindamycin 7 mg/kg/dose 3 times daily (max = 300 mg/dose) 10 days
Route: oral
Azithromycin 12 mg/kg once daily (max = 500 mg) 5 days
Route: oral
Clarithromycin 7.5 mg/kg/dose twice daily (max = 250 mg/dose) 10 days
Route: oral

23
 Attachment 7: Recommended Empiric Antibiotic Regimen for Acute Bacterial Sinusitis in
Pediatrics

Antibiotic Dose
First line Antibiotics
Amoxicillin-Clavulanate Standard dose
45 mg/kg/day (maximum 1.75 g/day)
High dose
90 mg/kg/day of the amoxicillin component, divided into two doses;
maximum 4 g/day)
Second line: Possible Antimicrobial Resistance
Cefdinir 14 mg/kg/day (maximum 600 mg/day) orally in a single dose or divided
into two doses
Cefpodoxime 10 mg/kg/day (maximum 400 mg/day)
Ceftriaxone (50 mg/kg/day every 12 hours; maximum 2 g/day)

Anaphylactic Hypersensitivity Reaction to Penicillin

levofloxacin 10–20 mg/kg/day (maximum 500 mg/day)

24
 Attachment 8: Management of Acute Otitis Media in Pediatrics

Otorrhea Unilateral OR bilateral Bilateral Acute otitis Unilateral AOM

with Acute AOM with severe media without without otorrhea
otitis media* symptoms** otorrhea
6 months -2 Antibiotics Antibiotics Antibiotics Antibiotics
years
≥ 2 years Antibiotics Antibiotics Antibiotics OR Antibiotics OR
additional additional
observation observation***
*Applies to well documented examination
**Toxic-appearing, persistent otalgia > 48 hrs., Temperature ≥39° C for 48hrs, or cannot ensure follow-
up
*** Mild symptoms (mild pain <48hrs and Temperature < 39° C)

25
 Attachment 9: Empiric Antibiotics for Acute Otitis Media in Pediatrics

No Penicillin Allergy
Amoxicillin:
• Is the antibiotic of choice if:
- The child has not received amoxicillin in the past 30 days.
- The child does not have concurrent purulent conjunctivitis.
• Dose: High dose Amoxicillin (90 mg/kg per day in 2 doses).
• Follow up the response to treatment within 48-72 hours.
• Duration:
- 10 days for children <2 years, TM perforation, or recurrent AOM.
- 5 to 7 days for children ≥2 years, no TM perforation, and no history of recurrent AOM.
Amoxicillin-clavulanate:
• Is the antibiotic of choice if:
- The child has received amoxicillin in the last 30 days.
- The child has concurrent purulent conjunctivitis.
- History of recurrent AOM unresponsive to amoxicillin.
- If the child failed the initial Amoxicillin therapy
• Dose: High-dose amoxicillin-clavulanate (90 mg/kg per day of amoxicillin component, with 6.4 mg/kg per day
of clavulanate in 2 divided doses).
• Duration: as above.
Ceftriaxone:
• In children who are vomiting or if there are situations in which oral antibiotics cannot be administered.
• Ceftriaxone (50 mg/kg per day) for three consecutive days, either intravenously or intramuscularly.
• De-escalation to oral antibiotic should be done as soon as the child can take orally

Penicillin Allergy
IgE mediated Mild non IgE mediated
• Azithromycin as a single dose of 10 mg/kg, OR • Cefdinir (14 mg/kg per day in 1 or 2 doses), OR
• Clarithromycin (15 mg/kg per day in 2 divided • Cefpodoxime (10 mg/kg per day, once daily), OR
doses), OR • Cefuroxime (30 mg/kg per day in 2 divided doses), OR
• Clindamycin 30 mg/kg per day orally divided • Cefuroxime tablets 250 mg orally every 12 hours for
into three doses (maximum 1.8 g/day children who weigh >17 kg and can swallow the tablet
whole, OR
• IV ceftriaxone.

26
Attachment 10: Management of Acute Otitis Media in Pediatrics

Refer to ENT or Pediatric

ID

27
 Attachment 11: Westley Croup Severity Score

Clinical feature Assigned score

Level of consciousness Normal, including sleep = 0
Disoriented = 5
Cyanosis None = 0
With agitation = 4
At rest = 5
Stridor None = 0
With agitation = 1
At rest = 2
Air entry Normal = 0
Decreased = 1
Markedly decreased = 2
Retractions None = 0
Mild = 1
Moderate = 2
Severe = 3
Severity of croup based on Westley croup score
Severity Mild moderate Severe Impending respiratory failure
Westly score ≤2 3 to 7 ≥8 ≥12
Description • no stridor at • stridor at • stridor at • Fatigue and listlessness
rest (although rest, rest, • Marked retractions
stridor may be • have at least • Retractions • Decreased or absent breath
present when mild are severe sounds
upset or retractions, • anxious, • Depressed level of
crying), • and may agitated, consciousness
• a barking have other pale and • Tachycardia out of
cough, symptoms or proportion to fever
fatigued.
• hoarse cry, signs of • Cyanosis or pallor
and either no or respiratory
distress,
only mild chest
little or no
wall/subcostal
agitation
retractions

28
 Attachment 12: Empiric Antibiotic Therapy for Acute Epiglottitis in Pediatrics

Two drug regimens

Ceftriaxone 50 – 100 mg/kg daily or in 2 divided doses
OR
Cefotaxime 150-200mg/kg/day divided in 4 doses
PLUS
Vancomycin 40-60mg/kg/day in 3 – 4 divided doses
Maximum dose 2 grams
OR
Clindamycin 30-40mg/kg/dose in 3 divided doses
Maximum 2.7 grams

29
 Attachment 13: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-positive Antibiogram
(UAE 2022)
1 January 2020 to 31 December 2022, Percent susceptible isolates (%S), Gram-positive bacteria (N=2,036)
Isolates from children (0-16), upper respiratory tract sources (throat only)

Organism Number AMX AMC AMP AZM FEP CTX FOX CRO CHL CIP CLI DAP DOX ERY GEN LVX LNZ MFX OFX OXA PEN RIF TEC TCY TGC SXT VAN
of
patients
Staphylococcus 365 79 6 66 73 84 100 98 66 93 73 100 77 70 10 100 99 91 100 88 99
aureus
Streptococcus 1,434 100 100 100 100 100 100 98 83 56 91 100 20 100 76 100
pyogenes
(GAS)
Streptococcus, 21 24 20
beta-haem.
Group B (GBS)
Streptococcus, 27 84
beta-haem.
Group C
Streptococcus, 40 100 79 100 86 50 100
beta-haem.
Group G
Streptococcus 45 100 97 100 93 78 49 100 100 100
dysgalactiae
Streptococcus 39 100 100 69 56 100 100 100 93 100 68 75 100
pneumoniae
Code Antibiotic Code Antibiotic Code Antibiotic
AMX Amoxicillin CLI Clindamycin OXA Oxacillin
Amoxicillin/Clavulanic
AMC DAP Daptomycin PEN Penicillin G
acid
AMP Ampicillin DOX Doxycycline RIF Rifampin
AZM Azithromycin ERY Erythromycin TEC Teicoplanin
FEP Cefepime GEN Gentamicin TCY Tetracycline
CTX Cefotaxime LVX Levofloxacin TGC Tigecycline
FOX Cefoxitin LNZ Linezolid SXT Trimethoprim/Sulfamethoxazole
CRO Ceftriaxone MFX Moxifloxacin VAN Vancomycin
CHL Chloramphenicol NIT Nitrofurantoin
CIP Ciprofloxacin OFX Ofloxacin

30
 Attachment 14: Cumulative Antimicrobial Susceptibility Pediatric Age, Gram-negative Antibiogram (UAE 2022)

January 2020 to 31 December 2022, Percent susceptible isolates (%Sa), Gram-negative bacteria (N=354)
Isolates from children (0-16), upper respiratory tract sources (throat only)

Organism Number AMK AMC AMP ATM FEP CFM CTX CAZ CRO CXM CIP ETP GEN IPM LVX MEM NOR PIP TZP TCY TIC TCC TOB SXT
of
patients
Pseudomonas 123 96 91 93 92 93 92 93 80 88 53 97
aeruginosa
Klebsiella 58 100 91 61 97 64 75 82 65 71 80 91 98 100 92 96 100 96 91 84
pneumoniae
Haemophilus 39 78 65 93 100 100 57
influenza

Code Antibiotic Code Antibiotic Code Antibiotic

AMK Amikacin CXM Cefuroxime NOR Norfloxacin
AMC Amoxicillin/Clavulanic CIP Ciprofloxacin PIP Piperacillin
acid
AMP Ampicillin COL Colistin TZP Piperacillin/Tazobactam
ATM Aztreonam ETP Ertapenem TCY Tetracycline
FEP Cefepime GEN Gentamicin TIC Ticarcillin
CFM Cefixime IPM Imipenem TCC Ticarcillin/Clavulanic acid
CTX Cefotaxime LVX Levofloxacin TOB Tobramycin
CAZ Ceftazidime MEM Meropenem SXT Trimethoprim/Sulfamethoxazole
CRO Ceftriaxone NIT Nitrofurantoin

31