From the Guidelines
For an acute upper respiratory tract infection (URTI), the recommended medications focus on symptom relief, with first-generation antihistamine/decongestant (A/D) preparations, such as brompheniramine and sustained-release pseudoephedrine, and naproxen being effective options. When considering treatment for URTI, it's crucial to understand that most cases are viral in origin and will resolve spontaneously 1. The use of antibiotics is not recommended for typical URTIs as they are ineffective against viruses and may contribute to antibiotic resistance 1. Key considerations for symptom management include:
- Over-the-counter medications like acetaminophen or ibuprofen for fever and pain reduction
- Decongestants such as pseudoephedrine for nasal congestion relief
- Antihistamines like diphenhydramine for runny nose and sneezing, although newer generation nonsedating antihistamines are ineffective for reducing cough 2
- Cough suppressants containing dextromethorphan or expectorants with guaifenesin for cough symptom management
- Saline nasal sprays and throat lozenges for additional comfort It's also important to note that staying hydrated, resting, and using a humidifier can complement medication therapy 1. If symptoms persist beyond 10-14 days or include high fever, severe headache, or difficulty breathing, medical attention should be sought 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat: Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcus species. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcus spp., or Haemophilus influenzae.
The recommended medication for an acute upper respiratory tract infection (URTI) is amoxicillin for oral suspension, for the treatment of infections due to susceptible isolates of:
- Streptococcus species (α-and β-hemolytic isolates only)
- Streptococcus pneumoniae
- Staphylococcus spp.
- Haemophilus influenzae 3
From the Research
Medications for Acute Upper Respiratory Tract Infection (URTI)
- For symptom management of the common cold, over-the-counter drugs such as acetaminophen, ibuprofen, or naproxen can be used for pain or fever, and antihistamines and/or decongestants can be used to treat congestion and runny nose 4, 5.
- Antibiotics are not recommended for viral URTIs, but may be prescribed for bacterial infections such as streptococcal pharyngitis, acute otitis media (AOM), or acute bacterial sinusitis 4, 6, 7.
- For streptococcal pharyngitis, penicillin V is the treatment of choice, given in two daily doses 6.
- For AOM, amoxicillin is the drug of choice, especially in children under 2 years of age or in older children with bilateral AOM, otorrhoea, co-morbidities, or severe illness 6.
- A combination of paracetamol and pseudoephedrine has been shown to be effective in treating nasal congestion and pain-related symptoms in URTI 8.
Specific Medications
- Acetaminophen: for pain or fever 4, 5
- Ibuprofen: for pain or fever 4, 5
- Naproxen: for pain or fever 5
- Antihistamines: for congestion and runny nose 4, 5
- Decongestants: for congestion and runny nose 4, 5
- Penicillin V: for streptococcal pharyngitis 6
- Amoxicillin: for AOM and acute bacterial sinusitis 6, 7
- Paracetamol-pseudoephedrine combination: for nasal congestion and pain-related symptoms in URTI 8