From the Guidelines
The recommended treatment for upper respiratory infections primarily focuses on symptom management, as most cases are viral and resolve on their own within 7-10 days, with antibiotics generally not recommended unless there's clear evidence of bacterial infection. The management of upper respiratory infections (URIs) should prioritize symptom relief and supportive care, given that the majority of these infections are caused by viruses and will resolve without specific treatment.
Symptom Management
- Over-the-counter medications like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 4-6 hours can help reduce fever and relieve pain 1.
- Nasal congestion can be treated with pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine 10mg every 4 hours.
- Antihistamines such as diphenhydramine (Benadryl) 25-50mg every 6 hours or loratadine (Claritin) 10mg daily may help with runny nose.
- Cough can be managed with dextromethorphan (found in many cough syrups) 10-30mg every 4-8 hours.
Non-Medication Approaches
- Rest adequately to help the body recover from the infection.
- Stay hydrated with warm fluids like tea with honey to soothe the throat and keep the respiratory system moist.
- Use saline nasal sprays to help loosen mucus and reduce nasal congestion.
- Consider using a humidifier to add moisture to the air, which can help relieve cough and congestion.
Antibiotic Use
Antibiotics are not recommended for the treatment of most upper respiratory infections unless there is clear evidence of a bacterial infection, such as symptoms persisting beyond 10-14 days, high fever, or purulent discharge 1. The decision to use antibiotics should be based on clinical judgment and consideration of the potential benefits and risks, including the contribution to antibiotic resistance.
Special Considerations
For patients who are seriously ill, who deteriorate clinically despite initial management, or who have recurrent episodes, referral to a specialist (such as an otolaryngologist, infectious disease specialist, or allergist) may be necessary 1. Additionally, patients at high risk of complications or secondary infection should be considered for antibiotics in the presence of lower respiratory features, with the preferred choice including co-amoxiclav or a tetracycline, and a macrolide or a fluoroquinolone active against S pneumoniae and S aureus as alternative choices in certain circumstances 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.
The recommended treatment for upper respiratory infections is amoxicillin for oral suspension, which is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus species, Streptococcus pneumoniae, Staphylococcus spp., or Haemophilus influenzae.
- The treatment should be continued 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.
- It is essential to note that amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria.
From the Research
Treatment Options for Upper Respiratory Infections
- The recommended treatment for upper respiratory infections typically involves symptom management with over-the-counter drugs, such as analgesics, zinc, nasal decongestants, and ipratropium for cough 3, 4.
- For children, the only established safe and effective treatments are acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils 3.
- Over-the-counter cold medications should not be used in children younger than four years 3, 4.
- Antibiotics are not recommended for upper respiratory tract infections unless symptoms worsen or do not improve after an additional 7 days, or if the patient has a bacterial etiology, such as streptococcal pharyngitis 4, 5.
Prevention and Management
- Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 3.
- Early intervention, such as the use of mucoadhesive gel nasal sprays, can help alleviate symptoms and prevent the development of a full-blown acute upper respiratory tract infection 6.
- Health care professionals should educate patients about available over-the-counter medications and the importance of reading package labeling for appropriate dosing and administration 7.