Upper respiratory tract infections, otitis media and tonsillitis
Who needs antibiotics for sore throat (people at risk of rheumatic fever), the deep neck infections not to miss, acute otitis media and sinusitis in adults, and the adult middle ear effusion that is nasopharyngeal cancer.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Most upper respiratory tract infections are viral and get better without antibiotics. Antibiotics for sore throat shorten symptoms by about a day at best and don't prevent most complications.
- The exception that matters in Australia is acute rheumatic fever. People at high risk get antibiotics for sore throat, often without waiting for a swab.
- Recognise the deep neck infections: peritonsillar abscess, Lemierre syndrome, epiglottitis. These need admission.
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Sources
- Therapeutic Guidelines: Antibiotic. Respiratory and ear, nose and throat infections (sore throat, acute otitis media, otitis externa, acute rhinosinusitis, epiglottitis)AU/NZTherapeutic Guidelines Limited (eTG complete), 2025 to 2026 staged update (topic version not verified)
- Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart diseaseAU/NZRHDAustralia (Menzies School of Health Research) and National Heart Foundation of Australia, 3rd edition, Edition 3.4 (October 2026 update)
- Sore throat (acute): antimicrobial prescribing (NG84)National Institute for Health and Care Excellence, 2018
- Sinusitis (acute): antimicrobial prescribing (NG79)National Institute for Health and Care Excellence, 2017
- Wilson JA et al. Tonsillectomy versus conservative management for adults with recurrent acute tonsillitis in the UK (NATTINA). Lancet 2023;401:2051-59The Lancet, 2023
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback