Should I prescribe antibiotics for a simple upper respiratory infection lasting 5 days?

Antibiotics for Upper Respiratory Infections

Antibiotics should not be prescribed for a simple upper respiratory infection lasting 5 days as these infections are primarily viral in origin and antibiotics provide no benefit while increasing the risk of adverse effects. 1, 2, 3

Understanding Upper Respiratory Infections

• Upper respiratory tract infections (URTIs) occur above the vocal cords with normal pulmonary auscultation and are predominantly viral in origin 1
• The common cold is a mild, self-limited illness characterized by symptoms such as sneezing, rhinorrhea, sore throat, cough, low-grade fever, headache, and malaise 1
• Most URTIs, including the common cold, are benign and self-limiting, resolving without antibiotic intervention 2, 3

Evidence Against Antibiotic Use in Simple URTIs

• Antibiotic treatment of adults with nonspecific upper respiratory tract infections does not enhance illness resolution 3
• Studies show that many URTIs are unnecessarily treated with antibiotics despite being viral in origin 2
• Purulent secretions from the nares or throat do not predict bacterial infection nor benefit from antibiotic treatment 3
• For the common cold, clinical guidelines explicitly state that antibiotics should not be prescribed as they are ineffective and lead to significantly increased risk of adverse effects 1
• In a meta-analysis of adults with acute rhinosinusitis, the number needed to treat was 18 for one patient to be cured rapidly, but the number needed to harm from antibiotic adverse effects was only 8 1

When to Consider Antibiotics for Respiratory Infections

Antibiotics should be reserved for specific conditions with clear indications:

• Acute bacterial rhinosinusitis: Only if symptoms have not improved after 10 days or have worsened after 5-7 days (double sickening) 1, 4
• High fever persisting >3 days: In cases of high fever (>38.5°C) persisting for more than 3 days, antibiotics may be considered 1
• Pneumonia: When there is clinical and radiological evidence of pneumonia 1
• Exacerbation of chronic obstructive bronchitis: When at least two of the three Anthonisen criteria are present (increased volume and purulence of expectoration, increased dyspnea) 1

Appropriate Management of Simple URTIs

• Patients should be advised that symptoms can last up to 2 weeks and should follow up if symptoms worsen or exceed the expected recovery time 1
• Symptomatic therapy is the appropriate management strategy for URTIs 1
• Options for symptomatic relief include:
  • Analgesics for pain and antipyretics for fever 1
  • Combination antihistamine-analgesic-decongestant products may provide symptom relief in some patients 1
  • Saline nasal irrigation may help alleviate symptoms 1
  • Systemic or topical decongestants, mucolytics, intranasal corticosteroids, and antihistamines tailored to specific symptoms 1

Risks of Inappropriate Antibiotic Use

• Contributes to antibiotic resistance in the community 2, 5
• Causes adverse drug events 2
• Adds unnecessary healthcare costs 2
• Can induce intestinal and respiratory dysbiosis, potentially worsening respiratory symptoms 6

Conclusion

For a simple upper respiratory infection lasting 5 days, antibiotics are not indicated as they provide no clinical benefit and increase the risk of adverse effects. Management should focus on symptomatic relief while the infection runs its natural course.