From the Guidelines
The first line of treatment for upper respiratory tract infections (URTIs) is supportive care, as most URTIs are viral in nature and resolve on their own within 7-10 days. This approach prioritizes the reduction of morbidity, mortality, and improvement of quality of life by avoiding unnecessary antibiotic use and its associated risks, such as antibiotic resistance 1.
Supportive Care Measures
Supportive care includes:
- Adequate rest
- Increased fluid intake to stay hydrated
- Over-the-counter medications to manage symptoms
- For pain and fever, acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (200-400 mg every 4-6 hours with food) can be used 1
- Nasal congestion can be relieved with saline nasal sprays or decongestants like pseudoephedrine (30-60 mg every 4-6 hours, not exceeding 240 mg daily) for up to 3 days to avoid rebound congestion
- For cough, dextromethorphan (15-30 mg every 6-8 hours) may help, while throat lozenges or warm salt water gargles can soothe sore throats
Antibiotic Use
Antibiotics are not recommended initially as they are ineffective against viruses and may contribute to antibiotic resistance 1. However, patients with persistent symptoms for more than 10 days, severe symptoms (fever >39 °C, purulent nasal discharge, or facial pain lasting for >3 consecutive days), or worsening symptoms after an initial period of improvement should be evaluated for possible bacterial infection and considered for antibiotic therapy 1.
When to Seek Medical Attention
Patients should seek medical attention if symptoms persist beyond 10 days, fever exceeds 101.3°F (38.5°C), or if they experience severe symptoms like difficulty breathing or persistent vomiting, as these may indicate a bacterial infection or complications requiring different treatment approaches 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 first line of treatment for upper respiratory tract infections is amoxicillin for oral suspension, as indicated in the treatment of infections due to susceptible isolates of specific bacteria, including Streptococcusspecies, Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae 2 2.
- 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.
- Amoxicillin should be taken at the start of a meal to minimize the potential for gastrointestinal intolerance.
From the Research
First Line of Treatment for Upper Respiratory Tract Infections
The first line of treatment for upper respiratory tract infections (URTIs) typically involves symptom management, as most URTIs are caused by viruses and do not require antibiotic treatment.
- For the common cold, recommended therapy involves symptom management with over-the-counter drugs, such as acetaminophen, ibuprofen, or naproxen for pain or fever, and antihistamines and/or decongestants to treat congestion and runny nose 3, 4, 5.
- Acute rhinosinusitis also typically is viral, and antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days 4.
- Acute pharyngitis also typically is of viral origin, and antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive 4, 6.
- Early antibiotic treatment may be indicated in patients with acute otitis media, group A beta-hemolytic streptococcal pharyngitis, epiglottitis, or bronchitis caused by pertussis 3, 6.
Role of Early Intervention
Early intervention can play a crucial role in managing URTIs, as it can reduce the chances of developing a full-blown acute URTI, decrease symptom severity, and reduce viral transmission 7.
- Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI, as they can create a barrier that can trap virus particles and deliver broad spectrum activity against a wide variety of pathogens that cause acute URTI 7.