What is the management of Upper Respiratory Tract Infection (URTI)?

From the Guidelines

Management of upper respiratory tract infections (URTIs) primarily involves supportive care since most cases are viral in nature. The most recent and highest quality study 1 emphasizes the importance of appropriate antibiotic use for acute respiratory tract infection in adults, advising against the use of antibiotics for viral infections.

Key Recommendations

• Rest, adequate hydration, and over-the-counter analgesics like acetaminophen (500-1000mg every 6 hours, not exceeding 4g daily) or ibuprofen (400-600mg every 6-8 hours with food) can help manage symptoms such as fever, headache, and myalgia.
• Saline nasal irrigation (using 240ml sterile water with 1/4 teaspoon salt, 2-3 times daily) can relieve nasal congestion, while throat lozenges or warm salt water gargles (1/2 teaspoon salt in 240ml warm water) may soothe sore throat.
• For nasal congestion, short-term use of decongestants like pseudoephedrine (60mg every 4-6 hours, maximum 240mg daily) for 3-5 days can provide relief.
• Antihistamines such as diphenhydramine (25-50mg every 6 hours) may help with rhinorrhea but can cause drowsiness.
• Antibiotics are generally not recommended unless bacterial infection is suspected, such as in streptococcal pharyngitis, sinusitis lasting over 10 days, or worsening symptoms after initial improvement 1.
• For bacterial infections, amoxicillin (500mg three times daily for 5-7 days) is often the first-line treatment, as recommended by 1 and 1.
• Patients should seek medical attention if symptoms persist beyond 10 days, fever exceeds 39.4°C (103°F), or if they experience severe headache, neck stiffness, difficulty breathing, or persistent vomiting.

Considerations

• The risk of side effects and the development of antibiotic-resistant pathogens should be considered when deciding whether to prescribe antibiotics 1.
• Patient education is fundamental to decreasing unnecessary prescriptions, and patients should be informed about the risks and benefits of antibiotic use 1.
• The diagnosis of nonspecific upper respiratory tract infection should be used to denote an acute infection that is typically viral in origin, and antibiotic treatment is not recommended unless bacterial infection is suspected 1.

From the FDA Drug Label

Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae.

• Management of URTI: Amoxicillin is indicated for the treatment of upper respiratory tract infections (URTI) caused by susceptible bacteria, including Streptococcus species, Streptococcus pneumoniae, Staphylococcus species, and Haemophilus influenzae.
• Key considerations:
  • Treatment should only be used for infections proven or strongly suspected to be caused by bacteria.
  • The patient should be treated for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained 2

From the Research

Management of URTI

• The management of upper respiratory tract infections (URTIs) aims to alleviate symptoms and prevent the transmission of the virus 3.
• Early intervention is crucial in reducing the severity of symptoms and preventing the development of complications 3.
• Mucoadhesive gel nasal sprays have shown promising results in the early intervention of acute URTI, creating a barrier that traps virus particles and prevents invasion of the mucosa 3.

Treatment Options

• Recommended therapy for the common cold involves symptom management with over-the-counter drugs, such as analgesics, zinc, nasal decongestants, and ipratropium for cough 4, 5.
• Antibiotics are not recommended for viral URTIs, unless symptoms worsen or do not improve after an additional 7 days 4.
• A combination of paracetamol and pseudoephedrine has been shown to be effective in treating nasal congestion and pain-related symptoms in URTI 6.

Prevention

• Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 5.
• Informing patients about the self-limited nature of the common cold can help manage expectations and limit antibiotic use 5.

Special Considerations

• Over-the-counter cold medications should not be used in children younger than four years 5.
• Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive 4.
• Acute otitis media can be managed without antibiotics, except in certain high-risk patients 4.