What is the treatment for upper respiratory infection?

Treatment for Upper Respiratory Infections

Most upper respiratory tract infections (URTIs) are viral in nature and should NOT be treated with antibiotics unless there is strong evidence of bacterial infection.

Determining Bacterial vs. Viral Etiology

Bacterial URTIs

• Bacterial URTIs require specific diagnostic confirmation before antibiotic treatment:
  • For streptococcal pharyngitis: Rapid antigen test (RAT) or throat culture is necessary to confirm Group A Streptococcus (GAS) 1
  • For sinusitis: Consider bacterial etiology if symptoms persist >10 days or worsen after initial improvement 2, 3
  • For otitis media: Diagnosis based on specific clinical findings 2

Common Bacterial Pathogens

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Group A beta-hemolytic Streptococcus (for pharyngitis) 4

Treatment Recommendations

Non-Antibiotic Management (First-Line for Most URTIs)

• Symptomatic treatment is the cornerstone of URTI management:
  • Analgesics/antipyretics (acetaminophen, ibuprofen) for pain and fever
  • Intranasal corticosteroids for nasal congestion
  • Adequate hydration and rest 2, 5
• Patient education about:
  • Expected duration of symptoms (typically 7-10 days)
  • When to seek further care
  • Importance of hand hygiene to prevent transmission 2

Antibiotic Treatment (Only for Confirmed Bacterial Infections)

First-Line Antibiotics

• Amoxicillin is the first-line antibiotic for most bacterial URTIs 2, 6
  • Adults: 875 mg twice daily
  • Children: 45 mg/kg/day divided twice daily
  • Duration: 5-7 days for uncomplicated cases 2

Alternative Antibiotics

• Amoxicillin-clavulanate: For patients with risk factors for resistant organisms
• Doxycycline: Alternative for patients who cannot tolerate amoxicillin
• Macrolides: Not recommended as first-line due to inadequate coverage for common URTI pathogens 2

Specific URTI Conditions

Common Cold

• Antibiotics should NOT be used for common cold 2, 3
• Symptomatic treatment only

Pharyngitis

• Antibiotic treatment only for confirmed GAS pharyngitis 1
• Penicillin V is the drug of choice for GAS pharyngitis 7
• Treatment should be initiated promptly after confirmation 1

Acute Sinusitis

• Most cases are viral and resolve without antibiotics
• Consider antibiotics only if:
  • Symptoms persist >10 days
  • Severe symptoms (high fever, purulent discharge)
  • Worsening symptoms after initial improvement 2, 3

Laryngitis

• Antibiotics not recommended 3
• Symptomatic treatment and voice rest

Antibiotic Stewardship Considerations

• Reassess after 48-72 hours of antibiotic therapy
• If no improvement or worsening after 72 hours, consider:
  • Alternative diagnosis
  • Switching antibiotics
  • Referral for specialist evaluation 2

Common Pitfalls to Avoid

1. Prescribing antibiotics for viral URTIs - This contributes to antibiotic resistance without providing benefit 2, 3
2. Not confirming bacterial etiology - Especially important for GAS pharyngitis 1
3. Using broad-spectrum antibiotics as first-line - Amoxicillin is sufficient for most bacterial URTIs 2
4. Inadequate treatment duration - Continue treatment for 48-72 hours beyond symptom resolution 6
5. Neglecting patient education - Patients should understand why antibiotics may not be prescribed and expected course of illness 2

Special Considerations

• Immunocompromised patients may require broader antibiotic coverage
• Recent antibiotic use (within 4-6 weeks) increases risk for resistant organisms
• Uncontrolled diabetes increases risk for S. aureus and gram-negative infections 2

Early intervention with symptomatic treatments can reduce severity and duration of symptoms, as well as decrease viral transmission 8.