Bacterial infections of the upper respiratory airways and beta-lactam antibiotics.

Infections of the upper respiratory tract, including the middle ear cleft, still create therapeutic problems. Although rhinitis is usually a virus infection, the infection of the paranasal sinuses are almost invariably of bacterial origin. Pneumococci, H. influenzae and anaerobes are the bacterial species most frequently isolated. In acute otitis media, pneumococci, H. influenzae and as demonstrated during the last few years, Branhamella catarrhalis constitutes the main pathogens. Anaerobes dominate the isolates in chronic otitis media, characterized by tissue destruction and sometimes intracranial complications. In acute tonsillitis and pharyngitis, Streptococcus pyogenes is the main bacterial pathogen whereas anaerobes are encountered in Vincent's angina, peritonsillar and parapharyngeal abscesses. The role of Branhamella in pharyngeal infections is still a subject of some dispute. In acute epiglottitis of children, H. influenzae is almost invariably isolated from the throat swabs and blood cultures. In adults, Streptococcus pyogenes and anaerobic bacteria also have to be considered as likely pathogens. The acute laryngitis has hitherto been regarded as a nonbacterial inflammation but there are reports indicating that Branhamella catarrhalis can be involved. Apparently the bacteriology of the upper respiratory tract infections have changed but little during the decades. The therapeutical problems of today are mainly due to decreased antibiotic susceptibility among the established pathogens, the presence of beta-lactamase production among bacterial species that establish the normal throat flora and lack of knowledge concerning the pathophysiology of infections of the mucous membranes.