Upper respiratory tract infections (pharyngitis, sinusitis and otitis media) are common and usually self-limiting conditions, most frequently caused by viruses. Despite this, in clinical practice an antibiotic is usually prescribed. The wide use of antibiotics contributes to development of bacterial resistance, which could have a great influence on public health. Distinguishing viral and bacterial upper respiratory tract infections represents a basis for rationale use of antibiotics. Clinical criteria alone are not sufficiently accurate in patients with pharyngitis to distinguish a cause of infection. Thus positive throat culture or rapid antigen detection test are required to establish the diagnosis of streptococcal pharyngitis. The first choice treatment is phenoxymethylpenicillin. Sinusitis and otitis media are similar in terms of cause, pathogenesis and treatment. Recognizing bacterial infection on basis of symptoms is extremely hard, thus therapy is mostly empirical. Management of pediatric acute otitis media might consider observation strategy with symptomatic treatment (48-72h) for uncomplicated cases, older than 6 months of age. If the symptoms do not improve, an antibiotic treatment is prescribed. Amoxicillin is preferred as the first-choice therapy of mild-symptoms otitis media and bacterial sinuzitis. The strict diagnostic criteria and use of antibiotic only in proven/highly suspected cases could contribute to reduction of antibiotic usage and the development of bacterial resistance.Infekcije gornjeg respiratornog trakta (faringitis, sinuzitis, otitis media) su veoma česta i obično samolimitirajuća oboljenja. Najčešće su uzrokovana virusima. Uprkos tome, u kliničkoj praksi, za terapiju ovih bolesti obično se propisuju antibiotici. Široka primena antibiotika doprinosi razvoju rezistencije bakterija, što može imati velike posledice za javno zdravlje. Razlikovanje virusne i bakterijske etiologije kod infekcija gornjih respiratornih puteva predstavlja osnov za racionalnu primenu antibiotika. Kod faringitisa, klinički kriterijumi nisu pouzdani za razlikovanje uzročnika. Za dijagnozu streptokoknog faringitisa potreban je pozitivan nalaz kulture brisa ždrela ili brzog antigenskog testa. Lek prvog izbora je fenoksimetilpenicilin. Sinuzitis i otitis media slični su po uzročnicima, patogenezi i terapiji. Prepoznavanje bakterijske infekcije na osnovu simptoma kod obe bolesti je izuzetno teško, pa je terapija uglavnom empirijska. Terapija akutnog otitisa media u dece starije od 6 meseci sa nekomplikovanom bolešću može početi praćenjem simptoma tokom 48-72 h, uz primenu simptomatske terapije. U slučaju da se simptomi ne umanje, uvodi se antibiotik. U lečenju akutnog otitisa media i bakterijskog sinuzitisa sa umerenim simptomima lek izbora je amoksicilin. Striktni dijagnostički kriterijumi i primena antibiotika samo u potvrđenim/visoko suspektnim bakterijskim infekcijama mogu doprineti smanjenju primene antibiotika i razvoja bakterijske rezistencije
