What are the preferred antibiotics for viral Upper Respiratory Tract Infection (URTI)?

From the Guidelines

Antibiotics are not recommended for viral upper respiratory tract infections (URTIs) as they are ineffective against viruses and will not improve symptoms or shorten the illness duration. Viral URTIs, which include the common cold, most cases of pharyngitis, and uncomplicated sinusitis, are self-limiting conditions that typically resolve within 7-10 days with supportive care alone. Using antibiotics for viral infections contributes to antibiotic resistance, exposes patients to unnecessary side effects like diarrhea, rash, and allergic reactions, and disrupts the normal gut microbiome 1.

Key Points to Consider

• The common cold, a benign, self-limited illness, is the most common acute illness in the United States, and antibiotics play no role in preventing its complications 1.
• Symptomatic therapy is the appropriate management strategy for the common cold, and antibiotics should not be prescribed because they are not effective and lead to significantly increased risk for adverse effects 1.
• Patients seeking medical advice for the common cold should be advised that symptoms can last up to 2 weeks and should be advised to follow up with the clinician if symptoms worsen or exceed the expected time of recovery 1.

Recommendations for Management

• Instead, symptom management with over-the-counter medications such as acetaminophen or ibuprofen for pain and fever, saline nasal sprays, and adequate hydration is recommended.
• If symptoms persist beyond 10-14 days, worsen after initial improvement, or are accompanied by high fever, severe pain, or difficulty breathing, patients should seek medical evaluation as these may indicate a bacterial superinfection or complications that might warrant antibiotic therapy 1.

Conclusion is not needed as per the guidelines, the above recommendations are based on the latest evidence from 1.

From the Research

Preferred Antibiotics for Viral Upper Respiratory Tract Infection (URTI)

There are no preferred antibiotics for viral Upper Respiratory Tract Infections (URTI) as antibiotics are ineffective against viral infections 2, 3, 4, 5.

Antibiotic Use in URTI

• Antibiotics are often prescribed for URTI, despite being ineffective against viral infections 3.
• The use of antibiotics in URTI is generally not recommended unless there is a bacterial infection present 2, 4, 6.
• Antibiotics may be prescribed for specific bacterial infections such as streptococcal pharyngitis, acute otitis media, and acute bacterial sinusitis 2, 4, 6.

Guidelines for Antibiotic Use

• The Infectious Diseases Society of Southern Africa has developed a guideline for the management of URTI, which recommends penicillin as the drug of choice for tonsillopharyngitis and amoxycillin for acute otitis media and acute bacterial sinusitis 6.
• Alternative antibiotic choices are also provided in the guideline, including amoxycillin-clavulanate, cephalosporins, macrolides, and respiratory fluoroquinolones 6.

Important Considerations

• The overuse of antibiotics contributes to the emergence of drug-resistant bacterial pathogens 3.
• Judicious, evidence-based use of antibiotics is necessary to contain costs and prevent adverse effects and drug resistance 4.