What is the management approach for upper respiratory infections?

From the Guidelines

The most effective management approach for upper respiratory infections involves a combination of nonpharmacological interventions, including mask use, hand hygiene, and social distancing, as recommended by the most recent evidence-based review 1. The management of upper respiratory infections (URIs) primarily involves supportive care and symptom relief while the infection resolves naturally. For most viral URIs, treatment includes:

• Adequate hydration
• Rest
• Over-the-counter medications for symptom management, such as:
  • Acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) to reduce fever and relieve pain
  • Nasal congestion may be treated with saline nasal sprays or short-term use of decongestants like pseudoephedrine (30-60 mg every 4-6 hours) for adults, though these should be avoided in patients with hypertension
  • Cough can be managed with dextromethorphan (15-30 mg every 6-8 hours) or honey (1 teaspoon as needed) for those over one year old Nonpharmacological interventions, such as:
• Mask use: wearing a mask is a strong recommendation for prevention of viral transmission 1
• Hand hygiene: hand hygiene is a strong recommendation for prevention of viral transmission 1
• Social distancing: social distancing is a recommendation in healthcare settings 1
• Saline nasal washing and gargling: these are options in selected populations 1 Antibiotics are generally not recommended for uncomplicated URIs as most are viral in origin, and unnecessary antibiotic use contributes to resistance. However, bacterial infections like strep throat require antibiotic treatment, typically penicillin V (500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days) 1. Patients should seek medical attention if symptoms persist beyond 10-14 days, if they experience high fever (>101.3°F or 38.5°C), severe sore throat, difficulty breathing, or if they have underlying conditions like asthma or COPD that may be exacerbated by respiratory infections. In healthcare settings, donning gloves, gowns, and eye protection are recommended 1, and visual alerts for patients at the entrance to ambulatory facilities instructing patients and accompanying persons to inform staff of symptoms of a respiratory tract infection 1 can help minimize transmission of influenza and other respiratory tract pathogens.

From the FDA Drug Label

Amoxicillin for oral suspension is a penicillin-class antibacterial indicated for treatment of infections due to susceptible strains of designated microorganisms Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat Infections of the Genitourinary Tract Infections of the Skin and Skin Structure Infections of the Lower Respiratory Tract

The management approach for upper respiratory infections includes the use of amoxicillin for oral suspension to treat infections caused by susceptible strains of designated microorganisms. The recommended dosage is:

• In Adults: 750 to 1750 mg/day in divided doses every 8 to 12 hours
• In Pediatric Patients over 3 Months of Age: 20 to 45 mg/kg/day in divided doses every 8 to 12 hours 2 Key considerations include:
• Dosage adjustment for patients with severe renal impairment
• Contraindications for patients with a history of serious hypersensitivity reactions to amoxicillin or other beta-lactams
• Monitoring for severe cutaneous adverse reactions, Clostridioides difficile-associated diarrhea, and other adverse reactions 2

From the Research

Management Approach for Upper Respiratory Infections

The management approach for upper respiratory infections (URIs) involves a combination of treatments to alleviate symptoms and prevent transmission. According to 3, informing patients about the self-limited nature of the common cold can help manage expectations and limit antibiotic use.

• Treatments with proven effectiveness for cold symptoms in adults include:
  • Over-the-counter analgesics
  • Zinc
  • Nasal decongestants with or without antihistamines
  • Ipratropium for cough
• For children, the only established safe and effective treatments are:
  • Acetylcysteine
  • Honey (for children one year and older)
  • Nasal saline irrigation
  • Intranasal ipratropium
  • Topical application of ointment containing camphor, menthol, and eucalyptus oils

Antibiotic Use in Upper Respiratory Tract Infections

Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis, as stated in 4 and 5. However, evidence supports antibiotic use in most cases of:

• Acute otitis media
• Group A beta-hemolytic streptococcal pharyngitis
• Epiglottitis
• A limited percentage of acute rhinosinusitis cases

Early Intervention and Prevention

Early intervention, administered prior to the peaking of viral shedding, can reduce the chances of developing a full-blown acute URTI, decrease symptom severity, and reduce viral transmission, as noted in 6. Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI. Counseling patients about the importance of good hand hygiene is also crucial in preventing transmission of cold viruses, as mentioned in 3.

• Strategies for early intervention include:
  • Mucoadhesive gel nasal sprays
  • Symptom alleviation
  • Prevention of URTI virus transmission
• Prevention methods include:
  • Good hand hygiene
  • Avoiding over-the-counter purchases that may not help
  • Limiting antibiotic use