The emergency room is the point of entry for many serious and potentially life-threatening infections seen in children. These encounters can run the spectrum of evaluation of nontoxic-appearing young febrile children with occult bacteremia to patients with septicemia, meningitis, and severe septic shock. However, the vast majority of infections seen in children presenting to emergency rooms, seem to be upper respiratory tract infections. These infections are frequently of viral etiology and it would appear that many clinicians are utilizing antibiotics as antipyretics in clinical situations where the overwhelming evidence is against bacterial etiology. The continued practice of inappropriate use of antimicrobials may exacerbate the current resistance patterns of many community-acquired bacterial pathogens. This may further complicate the antibiotic management of even immunocompetent children.