What is the treatment for upper respiratory infection (URI) in adults?

Treatment of Upper Respiratory Infections in Adults

Most upper respiratory infections (URIs) in adults are viral in origin and should be managed with supportive care only, avoiding unnecessary antibiotics. 1, 2

Diagnosis and Assessment

• Most uncomplicated URIs in adults are viral, typically presenting with symptoms such as cough, sneezing, rhinorrhea, sore throat, and nasal congestion 1
• Discolored nasal discharge alone does not indicate bacterial infection; it is a sign of inflammation and not specific for bacterial infection 1, 2
• Bacterial infection should be suspected only when specific clinical criteria are met 3

Initial Supportive Management for Viral URIs

• Analgesics/antipyretics such as acetaminophen or ibuprofen for pain, fever, and inflammation 1, 2
• Adequate hydration and rest as supportive measures 1
• Saline nasal irrigation for minor improvement in nasal symptoms 1
• Oral decongestants for symptomatic relief if no contraindications exist 1
• Antipyretics may be offered for fever 3

When to Consider Bacterial Infection

Antibiotics should be reserved for patients meeting specific clinical criteria for bacterial infections:

• Persistent symptoms for more than 10 days without clinical improvement 3
• Severe symptoms with high fever (>39°C), purulent nasal discharge, or facial pain lasting for at least 3 consecutive days 3
• Worsening symptoms following a typical viral URI that was initially improving (double sickening) 3

Antibiotic Selection When Indicated for Bacterial Rhinosinusitis

• For acute bacterial rhinosinusitis, amoxicillin is recommended by some professional societies including the American Academy of Allergy, Asthma & Immunology and the American Academy of Family Physicians 3
• Amoxicillin-clavulanate is the preferred agent according to the 2012 IDSA clinical practice guidelines, with doxycycline or a respiratory fluoroquinolone as alternatives 3
• For patients with penicillin allergy, doxycycline or a respiratory fluoroquinolone may be used 3
• Duration of treatment is typically 7-10 days 3

Management of Specific URI Types

Common Cold

• Self-limited viral infection that typically resolves in 7-10 days 4
• Symptomatic treatment only with analgesics, decongestants, and adequate hydration 3
• Antibiotics have no role in treatment 5

Acute Bacterial Rhinosinusitis

• Amoxicillin-clavulanate is the preferred antibiotic per IDSA guidelines 3
• Adjunctive therapy includes intranasal saline irrigation and intranasal corticosteroids 3
• Patients who are seriously ill or deteriorate despite antibiotic therapy should be referred to a specialist 3

Pharyngitis

• Test patients with symptoms suggestive of group A streptococcal pharyngitis by rapid antigen detection test and/or culture 3
• Treat only confirmed streptococcal pharyngitis with antibiotics 3
• For viral pharyngitis, provide symptomatic relief only 3

Common Pitfalls to Avoid

• Prescribing antibiotics for viral URIs is ineffective and contributes to antibiotic resistance 1, 2
• Relying on imaging studies to diagnose acute bacterial sinusitis is not recommended as it does not contribute to diagnosis and increases costs 3
• Assuming purulent nasal discharge indicates bacterial infection 1, 2
• Most patients diagnosed with acute rhinosinusitis have more adverse effects than benefits from antibiotics (number needed to treat = 18, number needed to harm = 8) 3

Follow-up Recommendations

• Advise patients to return if symptoms persist beyond 3 weeks, fever exceeds 4 days, dyspnea worsens, or if the patient stops drinking or consciousness decreases 2
• If a patient with suspected bacterial infection fails to respond to initial treatment within 48-72 hours, they should be reassessed 1
• Patients who are seriously ill, deteriorate clinically despite antibiotic therapy, or have recurrent episodes should be referred to a specialist 3