Upper respiratory tract infections (URTIs) are mostly caused by viruses. Antibiotic misuse for viral URTIs in children is a serious problem that not only results in selection of resistant strains of bacteria but also wastes millions of dollars each year in Taiwan. Antibiotic resistance among common respiratory bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis has become a major issue for public health. The common cold, acute pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, influenza and acute epiglottitis are the most frequently encountered acute URTIs in out-patient clinics. This article recommends the judicious use of antimicrobial agents for these seven common pediatric URTIs, based on local epidemiological data and the recommendations of the Infectious Disease Society of Taiwan and the American Academy of Pediatrics. With education and behavior modification, practitioners will help to reduce antibiotic overuse, and the goal of reducing antimicrobial resistance may be accomplished.