The tenet that children with acute purulent rhinitis (APR) need not be treated with antibiotics (Abx) unless drainage persists for 7-10 d is taught to students and residents but may not be adhered to in actual clinical practice. We sought to determine how APR is managed in the primary care setting by surveying all 450 pediatricians (PD) and family practitioners (FP) in northern Virginia. There were 346 (77%) evaluable responses, 145 from FP and 201 from PD. 71% of FP and 53% of PD (P=0.0007) immediately prescribe Abx for infants with scant green nasal mucopurulent secretions of 1 d duration; fewer would treat an older child immediately (50% FP vs. 24% PD,P=0.0000007). Only 15% of FP vs. 23% of PD (P=0.04) wait for 7-10 d of persistent purulent nasal drainage (PPND) in infants before giving Abx. 94% of FP and 95% of PD (P=0.49) indicated that they would prescribe Abx immediately for infants with APR who attend day care. For otitis-prone children who are not in day care, 86% of FP and 78% of PD(P=0.01) would also treat at once. The reasons for prompt Abx therapy are 1) the belief that many untreated patients will develop PPND (38% FP vs. 10% PD, P=0.0000004), 2) concern that acute otitis media would develop (44% FP vs. 24% PD, P=0.0008), 3) pressure from mothers (55% FP vs. 38% PD, P=0.01), and/or 4) desire to allow employed parents to return to work earlier (57% FP vs. 33% PD,P=0.0004). Amoxicillin was the initial choice for 89% of FP vs. 76% of PD (P=0.001), followed by trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. Decongestants are prescribed by 55% of FP vs. 36% of PD (P=0.001), and saline nose drops by two thirds of both groups; topical vasoconstrictors are rarely offered (4% FP vs. 5% PD,P=0.45). Most FP (89%) and PD (97%) were concerned about the increase in bacterial resistance rates stemming from unnecessary Abx prescribing (P=0.008). Conclusions: Most infants and children with APR of short duration are treated with Abx despite concerns over the spread of bacterial resistance; the practice is more prevalent among FP.(Funded by Glaxo Inc.)