From the Guidelines
The treatment approach for acute upper respiratory infections (URIs) primarily focuses on symptom management since most cases are viral and self-limiting.
Key Considerations
- Over-the-counter medications like acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) can reduce fever and relieve pain 1.
- Nasal congestion can be addressed with saline nasal sprays or decongestants like pseudoephedrine (30-60 mg every 4-6 hours, maximum 240 mg daily) for up to 3 days to avoid rebound congestion.
- Cough suppressants containing dextromethorphan (15-30 mg every 6-8 hours) may help with persistent cough, while antihistamines can reduce runny nose and sneezing.
- Adequate hydration, rest, and humidified air also provide relief.
Antibiotic Use
- Antibiotics are generally not recommended unless there's clear evidence of bacterial infection, such as symptoms persisting beyond 10-14 days, high fever, or purulent discharge 1.
- Bacterial infections may require antibiotics like amoxicillin (500 mg three times daily for 5-7 days) or azithromycin (500 mg on day one, then 250 mg daily for 4 days).
Rationale
These supportive measures work by reducing inflammation, thinning mucus, and supporting the body's natural immune response while the infection resolves.
Important Considerations
- The most recent and highest quality study 1 emphasizes the importance of appropriate antibiotic use for acute respiratory tract infections in adults, highlighting the need for a targeted approach to prescribing antibiotics.
- The study also notes that patient education is fundamental to decreasing unnecessary prescriptions, and that clinicians should reserve antibiotic treatment for patients with persistent symptoms or clear evidence of bacterial infection.
From the FDA Drug Label
Uses temporarily relieves cough due to minor throat and bronchial irritation as may occur with a cold controls cough to help you sleep temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: runny nose itching of the nose and throat sneezing itchy, watery eyes The treatment approach for acute upper respiratory infections may include temporarily relieving symptoms such as:
- Cough due to minor throat and bronchial irritation
- Runny nose
- Itching of the nose and throat
- Sneezing
- Itchy, watery eyes Using medications like dextromethorphan (PO) can help control cough and relieve these symptoms 2.
From the Research
Treatment Approach for Acute Upper Respiratory Infections
The treatment approach for acute upper respiratory infections (URIs) involves a combination of antimicrobial therapy, symptom relief, and general principles of patient care 3. The choice of antimicrobial drug depends on the causative agent, patient's age, condition, and potential allergic reactions.
Antimicrobial Therapy
- Antibiotics are effective against bacterial infections, but not against viral infections 4, 5, 6.
- The use of antibiotics for acute otitis media, sore throat, and streptococcal tonsillitis is discretionary, rather than mandatory, at least for non-severe cases 5.
- Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis 6.
Symptom Relief
- Medications such as acetaminophen, ibuprofen, or naproxen can be used to relieve pain and fever 4.
- Antihistamines and decongestants can be used to treat congestion and runny nose 4.
- A combination of paracetamol and pseudoephedrine has been shown to be effective in relieving nasal congestion and pain-related symptoms in upper respiratory tract infections 7.
General Principles of Patient Care
- The treatment approach should be individualized, taking into account the patient's specific needs and circumstances 3.
- Patients should be educated on the proper use of medications and the importance of completing the full course of treatment 3.
- Clinicians should weigh the benefits and risks of antibiotic use, considering the potential for adverse effects and antibiotic resistance 5, 6.