What are the recommended antibiotics for upper respiratory bacterial infections?

From the Guidelines

For upper respiratory bacterial infections, the recommended antibiotics typically include amoxicillin as first-line therapy at 1.5-4 g/day for 5-7 days for most adults, as indicated by the study published in Otolaryngology--head and neck surgery 1.

Key Considerations

• Amoxicillin-clavulanate (1.75-4 g/250 mg/day) is preferred when beta-lactamase producing bacteria are suspected, with a calculated clinical efficacy of 90-91% and bacteriologic efficacy of 97-99% 1.
• For penicillin-allergic patients, alternatives include doxycycline (81% clinical efficacy and 80% bacteriologic efficacy) or azithromycin, clarithromycin, erythromycin (77% clinical efficacy and 73% bacteriologic efficacy) 1.
• The choice of antibiotic should be based on the severity of the disease, recent antimicrobial use, and risk factors for infection with resistant pathogens, as outlined in the guidelines 1.

Important Notes

• Most upper respiratory infections are viral and do not require antibiotics, as stated in the principles of appropriate antibiotic use 1.
• Bacterial infections should be suspected with symptoms persisting beyond 10 days, severe symptoms, or worsening symptoms after initial improvement.
• Completing the full course of antibiotics is essential even if symptoms improve earlier to prevent antibiotic resistance and recurrence of infection.

Treatment Duration

• For sinusitis specifically, treatment duration is often extended to 10-14 days.
• The total daily dose of amoxicillin and the amoxicillin component of amoxicillin/clavulanate can vary from 1.5 to 4 g/day, with higher doses recommended for moderate disease or patients with risk factors for infection with resistant pathogens 1.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. The recommended antibiotics for upper respiratory bacterial infections include amoxicillin-clavulanate.

• The dosage for amoxicillin-clavulanate is one 875 mg/125 mg tablet every 12 hours or one 500 mg/125 mg tablet every 8 hours for more severe infections and infections of the respiratory tract 2.

  Clinical success rates in evaluable patients were 89% (108/122) for moxifloxacin hydrochloride Moxifloxacin is also effective against upper respiratory bacterial infections, with a clinical success rate of 89% 3. Clinical success rates (cure plus improvement) in the clinically evaluable population were 90.9% in the levofloxacin 750 mg group and 91.1% in the levofloxacin 500 mg group. Levofloxacin is another option, with clinical success rates of 90.9% and 91.1% for the 750 mg and 500 mg groups, respectively 4.

From the Research

Recommended Antibiotics for Upper Respiratory Bacterial Infections

The following antibiotics are recommended for the treatment of upper respiratory bacterial infections:

• Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been available for clinical use in a wide range of indications for over 20 years and is now used primarily in the treatment of community-acquired respiratory tract infections 5.
• Azithromycin and clarithromycin are also effective in the treatment of upper respiratory tract infections, with similar clinical efficacy and bacteriological eradication rates 6.
• Sultamicillin (Ampicillin/Sulbactan) is a potent beta-lactamase inhibitor that can be used to treat upper respiratory tract infections, with efficacy and safety similar to Amoxicillin/Clavulanate 7.
• Penicillin V is the treatment of choice for streptococcal infection, given in two daily doses 8.
• Amoxicillin is the drug of choice for acute otitis media (AOM) in children, with amoxicillin/clavulanate providing better coverage against beta-lactamase producing H. influenzae and M. catarrhalis in cases of treatment failure 8.

Considerations for Antibiotic Use

When considering antibiotic use for upper respiratory bacterial infections, the following points should be taken into account:

• Antibiotic treatment of adults with nonspecific upper respiratory tract infection does not enhance illness resolution and is not recommended 9.
• The diagnosis of nonspecific upper respiratory tract infection or acute rhinopharyngitis should be used to denote an acute infection that is typically viral in origin 9.
• Purulent secretions from the nares or throat do not predict bacterial infection or benefit from antibiotic treatment 9.
• Antibiotic treatment should be initiated promptly in all children <2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness 8.