What is the treatment for Upper Respiratory Tract Infections (URTI)?

Treatment for Upper Respiratory Tract Infections (URTI)

Most upper respiratory tract infections are viral in nature and should be managed with symptomatic treatment only, avoiding unnecessary antibiotics. 1

Diagnosis and Assessment

When evaluating a patient with URTI symptoms, consider:

• Duration of symptoms (bacterial infection more likely if >10 days)
• Fever pattern (high fever suggests bacterial infection)
• Presence of purulent discharge
• Specific symptoms (ear pain, facial pain, sore throat)

Signs of Bacterial Infection:

• Symptoms persisting >10-14 days
• Worsening symptoms after initial improvement
• Severe symptoms from onset (high fever, purulent discharge)
• Specific presentations suggesting bacterial etiology 1

Treatment Algorithm

1. Viral URTI (Most Common)

Symptomatic management only:

• Adequate hydration and rest
• Over-the-counter analgesics for pain/fever
• Saline nasal irrigation 1
• For dry, bothersome cough: dextromethorphan or codeine can be prescribed 2, 3
• For nasal congestion: pseudoephedrine for temporary relief 4

Important: Expectorants, mucolytics, antihistamines, and bronchodilators should NOT be prescribed in acute URTI in primary care 2

2. Bacterial URTI (Less Common)

Specific conditions requiring antibiotics:

• Streptococcal pharyngitis: Confirm with rapid strep test or throat culture before prescribing. Use penicillin or amoxicillin for 10 days 2, 1
• Bacterial sinusitis: Consider if symptoms last >10 days or worsen after initial improvement. Use amoxicillin as first-line treatment 2, 1
• Bacterial URTI with persistent purulent sputum: Amoxicillin-clavulanate 875/125 mg twice daily for 7 days 1

Alternative antibiotics:

• For penicillin allergy: Macrolides such as azithromycin (500 mg once daily for 3 days or 500 mg on day 1 followed by 250 mg daily for 4 days) 1
• For areas with high resistance: Consider levofloxacin or moxifloxacin 2

Special Populations

High-Risk Patients

Consider earlier antibiotic intervention in:

• Patients aged >65 years with acute cough and comorbidities
• Patients with cardiac failure
• Insulin-dependent diabetes mellitus
• Serious neurological disorders
• Immunocompromised patients 2, 1

Follow-up and Monitoring

• Advise patients to return if symptoms persist beyond 3 weeks 2
• Clinical effects of antibiotic treatment should be expected within 3 days 2, 1
• If no improvement after 72 hours of antibiotics, consider:
  • Changing antibiotics
  • Reevaluating diagnosis
  • Hospital referral 1

Common Pitfalls to Avoid

1. Overprescribing antibiotics: URTIs are the most common reason for inappropriate antibiotic prescriptions, contributing to antibiotic resistance 5, 6

2. Inadequate symptom management: Failing to provide effective symptomatic relief can lead to unnecessary return visits and patient dissatisfaction

3. Missing bacterial infections: While most URTIs are viral, failing to identify the small percentage that are bacterial can lead to complications

4. Inappropriate medication use: Using expectorants, mucolytics, antihistamines, and bronchodilators is not recommended and may cause unnecessary side effects 2

5. Delayed intervention in high-risk patients: Lower threshold for treatment should be applied to elderly patients with comorbidities 1, 7

By following this evidence-based approach, clinicians can effectively manage URTIs while minimizing unnecessary antibiotic use and optimizing patient outcomes.