What is the treatment for upper respiratory infection?

Treatment for Upper Respiratory Tract Infections

Most upper respiratory tract infections (URTIs) are viral in origin and should be managed with symptomatic treatment rather than antibiotics. 1, 2

Classification and Diagnosis

• URTIs include infections occurring above the vocal cords with normal pulmonary auscultation, such as acute rhinosinusitis and acute otitis media 3
• Initial clinical assessment is essential to distinguish between upper and lower respiratory tract infections 4, 3

General Management Approach

• For viral URTIs (most common):
  • Symptomatic treatment with over-the-counter medications for fever, muscle aches, cough, runny nose, and nasal congestion 5
  • Early intervention with symptomatic treatment can reduce severity and duration of symptoms 6
  • Antibiotics are not indicated for common cold or viral laryngitis 2

Specific Treatment Recommendations by Condition

Common Cold

• Primarily managed with symptomatic treatment 1
• Over-the-counter medications can help relieve symptoms 5
• Antibiotics should not be prescribed 2

Acute Rhinosinusitis

• Bacterial etiology should be suspected if:
  • Symptoms persist beyond 10 days
  • Temperature exceeds 39°C (102.2°F)
  • Symptoms worsen after initial improvement 1
• For confirmed bacterial sinusitis, recommended antibiotics include:
  • Amoxicillin-clavulanate
  • Second-generation oral cephalosporins (cefuroxime-axetil)
  • Third-generation oral cephalosporins (cefpodoxime-proxetil, cefotiam-hexetil) 4, 3
• For patients with beta-lactam allergies, pristinamycin is recommended 4, 3
• Standard treatment duration is 7-10 days 4, 3

Acute Pharyngitis

• Antibiotics should only be prescribed if tests confirm group A beta-hemolytic streptococcal infection 1, 2
• For streptococcal pharyngitis, amoxicillin is indicated at 3g/day for adults 4, 7

Special Considerations

Antibiotic Selection When Indicated

• For suspected resistant organisms:
  • Amoxicillin-clavulanate
  • Cefuroxime-axetil
  • Cefpodoxime-proxetil 4, 3
• Fluoroquinolones active against pneumococci (levofloxacin, moxifloxacin) should be reserved for complicated cases or treatment failures 4

Duration of Treatment

• When antibiotics are indicated:
  • Sinusitis: 7-10 days 4
  • Streptococcal pharyngitis: 10 days 3
  • Treatment should continue for 48-72 hours beyond symptom resolution 7

Pediatric Considerations

• In children under 3 years with high fever (>38.5°C) persisting for more than 3 days, consider:
  • Amoxicillin-clavulanate
  • Cefuroxime-axetil
  • Cefpodoxime-proxetil 4
• FDA advises against using over-the-counter cold medications in children younger than 6 years 1

Common Pitfalls to Avoid

• Prescribing antibiotics for viral URTIs, which represent the majority of cases 1, 2
• Failing to distinguish between viral and bacterial etiologies based on clinical presentation and duration 1
• Using antibiotics before completing an adequate observation period for self-limited conditions 2
• Not considering resistant organisms when selecting antibiotics for confirmed bacterial infections 4