What is the management and treatment for upper respiratory infection?

Management and Treatment of Upper Respiratory Infections

Most upper respiratory tract infections (URTIs) are viral and self-limiting, requiring only symptomatic management rather than antibiotics. 1, 2

Diagnostic Approach

• Distinguish between viral and bacterial etiology:
  • Viral URTIs (most common): Short duration, mild symptoms, gradual onset
  • Bacterial infection more likely if:
    • Symptoms persist >10 days
    • Temperature >39°C (102.2°F)
    • Symptoms worsen after initial improvement 2

Treatment Algorithm

1. Symptomatic Management (First-line for most URTIs)

• Nasal saline irrigation: Reduces symptom severity, especially in children 3
• Over-the-counter medications:
  • Analgesics/antipyretics for pain and fever
  • Decongestants for nasal congestion
  • Caution: Not recommended for children <6 years 2

2. Antibiotic Therapy (Only for confirmed/strongly suspected bacterial infections)

When bacterial infection is suspected based on clinical criteria:

• First-line: Amoxicillin (3 g/day for adults) 4, 1
• Alternative options (based on local resistance patterns and patient factors):
  • Amoxicillin-clavulanate: For beta-lactamase-producing pathogens 5
    • Adults: 875 mg/125 mg every 12 hours or 500 mg/125 mg every 8 hours 5
    • Children: 45 mg/kg/day divided every 12 hours 5
  • Macrolides: For penicillin-allergic patients 1
  • Tetracyclines: Alternative first-line option for adults 1

Specific URTI Management

Common Cold

• Primarily symptomatic management
• Antibiotics not indicated 2
• Early intervention with mucoadhesive nasal sprays may reduce severity 6

Acute Rhinosinusitis

• Initially symptomatic management
• Consider antibiotics only if:
  • Symptoms persist >10 days
  • Severe symptoms (fever >39°C)
  • Worsening after initial improvement 2
• When antibiotics indicated: Amoxicillin or amoxicillin-clavulanate 1, 5

Acute Pharyngitis

• Test before treating: Only prescribe antibiotics for confirmed streptococcal pharyngitis 2
• Confirm diagnosis with rapid antigen test or throat culture 1
• Amoxicillin is first-line treatment for streptococcal pharyngitis 1

Acute Otitis Media

• Can be managed without antibiotics except in:
  • Children <6 months
  • Children 6-23 months with bilateral AOM
  • Children >2 years with bilateral AOM and otorrhea
  • High-risk patients 2
• When antibiotics indicated: Amoxicillin (standard dose) or amoxicillin-clavulanate 1, 5

Monitoring and Follow-up

• Assess response within 48-72 hours of starting antibiotics
• Do not change treatment within first 72 hours unless clinical worsening 4
• Consider alternative diagnosis or treatment if no improvement after 72 hours 1

Prevention Strategies

• Hand hygiene and infection control measures reduce transmission, particularly in children under 24 months 7
• Educate patients on expected duration of symptoms (typically 7-10 days) 1
• Emphasize completing full antibiotic course when prescribed 1

Important Caveats

• Antibiotics should not be used for viral infections (common cold, viral rhinosinusitis, acute bronchitis, laryngitis) 1
• Inappropriate antibiotic use contributes to resistance and adverse events 1
• Consider local resistance patterns when selecting antibiotics 1
• Amoxicillin-clavulanate should be taken at the start of a meal to minimize gastrointestinal intolerance 5