Respiratory tract infections in under 5s represent two thirds of all presentations to primary care and ED. But why do we see so many of them? What are parents looking for when they bring their children to see a doctor? Dr Sanjay Patel, consultant in paediatric infectious diseases, says the data tells us that parents are not seeking antibiotics, but rather reassurance that their child is well enough to be managed at home without antibiotics. With the emphasis in popular media on serious illness, health-seeking behaviour is going up year on year, with a 25% increase in activity for under 5s with RTIs annually. In our increasingly risk-averse society, there needs to be a seismic change in health seeking behaviour, if we are to avoid the dangers associated with inappropriate antibiotic use. Severity, not aetiology of respiratory tract infections should guide decision making around antibiotic use. Reference is made to the SCAN Guidelines, which can be found at www.nhsantibioticguidelines.org.uk the PIER Guidelines at www.piernetwork.org and the MicroGuide app. Changes to antibiotic policy aim to improve compliance and include use of Amoxicillin for all respiratory tract infections, with a BD dosing regime of 40mg/kg, as well as shortening the course from 10 to 7 days in tonsillitis. Scoring systems discussed include FeverPAIN for suspected Group A Strep tonsillitis. Pneumonia can be diagnosed based on fever, and respiratory distress, with auscultation providing little to support a diagnosis.

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