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

Treatment for Upper Respiratory Tract Infections (URTIs)

Most URTIs are viral in origin and do not require antibiotics. Treatment should focus on symptomatic management, with antibiotics reserved only for specific bacterial complications. 1, 2

Diagnosis and Classification

Viral vs. Bacterial Differentiation

• Consider bacterial infection when:
  • Symptoms persist >10-14 days
  • Symptoms worsen after initial improvement
  • Severe symptoms from onset (high fever, purulent discharge)
  • Fever persists for more than 3 days 2

High-Risk Patients

• Patients aged >65 years
• Those with chronic conditions (COPD, diabetes, heart failure)
• Immunocompromised individuals
• Patients taking oral glucocorticoids
• Recent hospitalization or antibiotic use 2

Treatment Algorithm

1. Non-complicated URTI (Common Cold)

• Symptomatic treatment only 1, 2:

  • Adequate hydration
  • Rest
  • Over-the-counter analgesics for pain/fever
  • Saline nasal irrigation
  • Pseudoephedrine for nasal congestion 3
  • Dextromethorphan or codeine for bothersome dry cough 2

• DO NOT USE 2:

  • Antibiotics (Grade B recommendation) 1
  • Expectorants, mucolytics, antihistamines, or bronchodilators without specific indications

2. URTI with Suspected Bacterial Complications

When to Consider Antibiotics:

• Acute rhinosinusitis with:

  • Symptoms lasting >10 days with no improvement
  • Severe symptoms or high fever (>39°C/102.2°F)
  • Worsening symptoms after initial improvement 2, 4

• Streptococcal pharyngitis:

  • Only with positive rapid strep test or culture 2, 4

• High-risk patients with signs of bacterial infection 2

Antibiotic Selection:

• First-line: Amoxicillin-clavulanate (875/125 mg twice daily for 7 days) 2
• For penicillin allergy: Azithromycin (500 mg once daily for 3 days or 500 mg day 1, then 250 mg daily for 4 days) 2
• In areas with high resistance: Consider respiratory fluoroquinolones 2

Special Considerations

Early Intervention

• Early symptomatic treatment may reduce severity and duration of viral URTIs 5
• Mucoadhesive gel nasal sprays may help create a barrier against viral particles 5

Antibiotic Stewardship

• Inappropriate antibiotic use for URTIs is a major public health concern 1, 6
• Most URTIs are self-limiting and resolve within 7-10 days regardless of antibiotic use 1
• Antibiotics should not be obtained without medical prescription or evidence-based indication 1

Follow-up Recommendations

• Advise patients to return if:
  • Symptoms persist beyond 3 weeks
  • Symptoms worsen after initial improvement
  • New symptoms develop 2
• Clinical improvement should be seen within 72 hours of starting antibiotics; if not, reevaluate diagnosis 2

Prevention

• Annual influenza vaccination for high-risk individuals
• Pneumococcal vaccination according to current guidelines
• Hand hygiene and avoiding close contact with infected individuals 2