Background and aim. This study aims to assess differences in antibiotic prescribing and incidence of Upper Respiratory Tract Infections (URTIs) between 1987 and 2001, before (1987) and after (2001) publication of Dutch guidelines on URTIs. Design, setting and method. Data were collected in two national surveys: 96 general practices (n = 344 449 patients) in 1987 and 90 general practices (n = 358 008 patients) in 2001. Outcome measures were: (1) antibiotic prescribing rates for acute otitis media (AOM), common cold, sinusitis and acute tonsillitis; (2) number of antibiotic prescriptions per 1000 patients per year; (3) incidence rates per 1000 patients per year. Results. Antibiotic prescribing rates in AOM and common cold were increased in 2001 compared to 1987 (from 27% to 48%; from 17% to 23%, respectively), while the rates for sinusitis and acute tonsillitis were about the same (72% and 70%; 74% and 72%, respectively). Except for AOM, the number of antibiotic prescriptions per 1000 patients decreased by 30% to 50%. As incidence rates of common cold, tonsillitis and sinusitis decreased, the decline in the total volume of antibiotic prescriptions per 1000 patients for these three categories has mainly to be attributed to a fall of incidence rates. Conclusion. Antibiotic prescribing rates for URTIs have not declined between 1987 and 2001, but the volumes for common cold, sinusitis and tonsillitis have fallen down mainly attributable to declined incidences, which have probably been caused by a reduced inclination of patients to present respiratory illness to their GP. Prescribing antibiotics for AOM has increased.