Treatment for Upper Respiratory Tract Infections
Most upper respiratory tract infections (URTIs) are viral in origin and do not require antibiotics; treatment should focus on symptom management while reserving antibiotics only for specific bacterial infections with clear diagnostic criteria. 1, 2
Diagnostic Approach for URTIs
Common Cold (Viral Rhinitis)
- Characterized by: Nasal congestion, rhinorrhea, sneezing, sore throat
- Management: Symptomatic treatment only; antibiotics are not indicated 2
Acute Rhinosinusitis
Bacterial sinusitis is more likely if:
- Symptoms persist >10 days
- Temperature >39°C (102.2°F)
- Symptoms worsen after initial improvement 1
Pharyngitis
- Antibiotics only if Group A Streptococcal infection is confirmed by testing 1
- Viral pharyngitis: Symptomatic treatment only
Treatment Algorithm
1. Symptomatic Treatment (First-line for most URTIs)
- Pain/Fever: Acetaminophen or NSAIDs 3
- Both aspirin and acetaminophen at doses of 500-1000mg are effective for fever and symptom relief
- Congestion: Consider decongestants (not recommended for children <6 years) 1
- Hydration: Adequate fluid intake
- Rest: Encourage adequate rest
2. Specific Antibiotic Treatment (Only for confirmed bacterial infections)
For Acute Bacterial Sinusitis:
First-line antibiotics include 4:
- Amoxicillin-clavulanate
- Second-generation cephalosporins (cefuroxime-axetil)
- Third-generation cephalosporins (cefpodoxime-proxetil, cefotiam-hexetil)
- Pristinamycin (for beta-lactam allergies)
Duration: 7-10 days (5 days may be sufficient for certain cephalosporins) 4
For Streptococcal Pharyngitis:
- Only after positive test/culture for Group A Streptococcus 1, 2
- Amoxicillin is indicated for susceptible (β-lactamase-negative) streptococcal infections 5
Important Considerations
When to Avoid Antibiotics
- Common cold
- Viral pharyngitis
- Early viral rhinosinusitis
- Laryngitis 2
When to Consider Early Intervention
- Early intervention with symptomatic treatments may reduce severity and duration of symptoms 6
- Mucoadhesive nasal sprays may help create a barrier against viral particles 6
Antibiotic Stewardship
- Inappropriate antibiotic use contributes to resistance and adverse events 2
- Most URTIs resolve without antibiotics within 7-10 days 7
Special Populations
- Children: More conservative approach to antibiotic use
- For acute otitis media: Antibiotics only for children <6 months, bilateral AOM in children 6-23 months, or bilateral AOM with otorrhea in children >2 years 1
Red Flags Requiring Urgent Attention
- Severe symptoms of frontal, fronto-ethmoidal, or sphenoidal sinusitis may require fluoroquinolones and closer monitoring 4
- Acute ethmoiditis with fever and painful eyelid edema requires hospitalization and parenteral antibiotics 4
Pitfalls to Avoid
- Prescribing antibiotics for viral infections
- Failing to distinguish between viral and bacterial sinusitis
- Not considering symptom duration in decision-making
- Using fluoroquinolones as first-line therapy (should be reserved for complications or treatment failures) 4