Upper respiratory tract infection (URTI) in children is one of the most common problems that general practitioners (GPs) see. Although complications from URTIs are rare, and antibiotics offer little or no benefit in uncomplicated cases, antibiotic prescribing has increased in recent years following a decline in the late 1990s. This article explores possible reasons for the increase, weighs the evidence on withholding antibiotics and asks how GPs will interpret recent National Institute for Health and Clinical Excellent (NICE) guidelines when dealing with URTI in children. We review some of the latest approaches to help implement antibiotic prescribing guidelines and suggest some practical solutions to help busy GPs.