From the Guidelines
Treatment for an upper respiratory infection (URI) primarily involves supportive care since most URIs are viral and resolve on their own within 7-10 days. Start with rest, adequate hydration, and over-the-counter medications to manage symptoms. For fever and pain, take acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours as needed. Nasal congestion can be relieved with saline nasal sprays or decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours, though decongestants should be limited to 3-5 days to prevent rebound congestion. For cough, try dextromethorphan (Robitussin DM) 10-20mg every 4 hours or honey in warm tea. A humidifier can help ease breathing and sore throat.
Key Considerations
- Antibiotics are not effective for viral URIs and should only be considered if a bacterial infection is suspected, typically after symptoms persist beyond 10-14 days or significantly worsen after initial improvement 1.
- If symptoms are severe, include difficulty breathing, persistent high fever above 101.5°F for more than three days, or symptoms lasting beyond two weeks, medical attention should be sought as these may indicate complications or a bacterial infection requiring different treatment.
- The most recent and highest quality study, a 2020 European position paper on rhinosinusitis and nasal polyps, recommends reserving antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1.
From the FDA Drug Label
Adults and Pediatric Patients Upper Respiratory Tract Infections of the Ear, Nose, and Throat:Amoxicillin for oral suspension is indicated in the treatment of infections due to susceptible (ONLY β-lactamase–negative) isolates of Streptococcusspecies. (α-and β-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcusspp., or Haemophilus influenzae.
Treatment for URI: Amoxicillin is indicated for the treatment of upper respiratory tract infections (URI) caused by susceptible bacteria, including Streptococcus species, Streptococcus pneumoniae, Staphylococcus species, and Haemophilus influenzae 2 2.
- Key points:
- Amoxicillin should only be used to treat infections proven or strongly suspected to be caused by bacteria.
- The treatment should be continued for a minimum of 48 to 72 hours beyond the time the patient becomes asymptomatic or evidence of bacterial eradication has been obtained.
From the Research
Treatment Options for Upper Respiratory Infections (URIs)
- Medications such as acetaminophen, ibuprofen, or naproxen can be used to treat pain or fever, while antihistamines and/or decongestants can help alleviate congestion and runny nose 3
- Antibiotics are not effective against viral URIs and should only be used when a bacterial infection is present 3, 4, 5
- Early intervention with mucoadhesive gel nasal sprays has shown promise in reducing the severity of symptoms and preventing the transmission of URI viruses 6
Management of Acute Upper Respiratory Tract Infections
- The current management strategies aim to alleviate symptoms and prevent the transmission of URI viruses, with early intervention being key to reducing the severity of symptoms and preventing complications 6
- A targeted literature review and expert roundtable have established guidelines for the management of acute upper respiratory tract infections, emphasizing the importance of early intervention and evidence-based treatment 6
- Pediatricians should be aware of the most common upper respiratory infections in children and take a critical approach to diagnosis and treatment to avoid unnecessary diagnostic tests and harmful treatments 7
Antibiotic Use in Upper Respiratory Tract Infections
- Antibiotics should only be used in cases where a bacterial infection is present, such as acute otitis media, group A beta-hemolytic streptococcal pharyngitis, epiglottitis, or bronchitis caused by pertussis 4, 5
- Antibiotics should not be used to treat the common cold, influenza, COVID-19, or laryngitis, as this can contribute to antibiotic resistance and adverse events 4, 5