How to approach an acute upper respiratory tract infection?

From the Guidelines

Approach an acute upper respiratory tract infection by first determining if it's likely viral or bacterial in nature, and most cases are viral and require supportive care. The majority of acute upper respiratory tract infections are self-limited and can be managed with symptomatic relief measures, such as rest, adequate hydration, and over-the-counter medications for symptom relief 1. For fever and pain, use acetaminophen (325-650mg every 4-6 hours, maximum 3000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) 1. Nasal congestion can be treated with pseudoephedrine (30-60mg every 4-6 hours) or phenylephrine (10-20mg every 4 hours), while a saline nasal spray can help moisturize nasal passages 1.

Some key points to consider when approaching an acute upper respiratory tract infection include:

• Most cases are viral and do not require antibiotic therapy 1
• Symptomatic relief measures, such as rest, hydration, and over-the-counter medications, are often sufficient for management 1
• Antibiotics should be reserved for cases where a bacterial infection is suspected, such as symptoms persisting beyond 10-14 days, purulent nasal discharge, or high fever 1
• Prevention includes regular handwashing, avoiding close contact with sick individuals, and maintaining good overall health through adequate sleep and nutrition 1

It's also important to note that:

• The common cold is a benign, self-limited illness that does not require antibiotic therapy 1
• Acute rhinosinusitis is a self-limited infection that usually resolves without antibiotics, even in patients with a bacterial cause 1
• Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and other antibacterial drugs, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria 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

Approach to Acute Upper Respiratory Tract Infection:

• Diagnosis: Confirm the infection is caused by a susceptible bacteria, such as Streptococcus species, Streptococcus pneumoniae, Staphylococcus spp., or Haemophilus influenzae.
• Treatment: Use amoxicillin only if the infection is proven or strongly suspected to be caused by bacteria.
• Dosage: Follow the recommended dosage for adults and pediatric patients aged 3 months and older, as outlined in the drug label 2 and 2.
• Duration: Continue treatment for a minimum of 48 to 72 hours beyond the time the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained.
• Key Considerations:
  • Always consider local epidemiology and susceptibility patterns when selecting empiric therapy.
  • Use amoxicillin with caution and only when necessary to reduce the development of drug-resistant bacteria.

From the Research

Approach to Acute Upper Respiratory Tract Infection

To approach an acute upper respiratory tract infection (URTI), it is essential to understand the causes, symptoms, and appropriate management strategies.

• URTIs include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM) 3.
• These infections are typically viral, but can be caused by bacteria in some cases 3, 4, 5.

Diagnosis and Management

• The diagnosis of URTIs is usually based on clinical presentation, and antibiotics should only be prescribed when a bacterial etiology is suspected or confirmed 3, 4, 5.
• For the common cold, symptom management with over-the-counter drugs is recommended, although the Food and Drug Administration advises against their use in children younger than 6 years 3.
• Acute rhinosinusitis and pharyngitis are also typically viral, and antibiotics should only be considered if symptoms worsen or do not improve after an observation period 3, 4, 5.
• AOM can be managed without antibiotics in most cases, except in certain high-risk patients or those with severe symptoms 3, 4, 5.

Prevention and Treatment

• Early intervention, such as the use of mucoadhesive gel nasal sprays, can help alleviate symptoms and prevent the transmission of URTI viruses 6.
• Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants, and ipratropium for cough 7.
• Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 7.
• The use of antibiotics should be judicious and evidence-based to contain costs, prevent adverse effects, and reduce the risk of antibiotic resistance 4, 5.