What is the recommended treatment plan for a 15-year-old with an upper respiratory infection?

Treatment Plan for a 15-Year-Old with Upper Respiratory Infection

Most adolescents with uncomplicated upper respiratory infections should receive supportive care only—no antibiotics—with symptom management using analgesics for pain, antipyretics for fever, and adequate hydration. 1

Initial Assessment and Management Approach

The vast majority of URIs in adolescents are viral and self-limited, resolving within 7-10 days without antibiotic therapy. 1 Your primary goal is to determine whether this is a simple viral URI requiring only supportive care, or if specific features suggest a bacterial complication warranting antibiotics.

Supportive Care (First-Line for All Patients)

All patients with URI should receive:

• Analgesics (acetaminophen or ibuprofen) for pain relief 1
• Antipyretics for fever control (avoid aspirin in patients under 16 years due to Reye's syndrome risk) 1
• Adequate hydration 1
• Symptomatic relief options including:
  • Saline nasal irrigation 1
  • Systemic or topical decongestants (topical use limited to 3 days maximum to avoid rhinitis medicamentosa) 1
  • Intranasal corticosteroids for nasal congestion 1

When Antibiotics Are NOT Indicated

Do not prescribe antibiotics for:

• Simple viral URI/common cold with nasal congestion, rhinorrhea, and mild symptoms 1
• Acute rhinosinusitis with symptoms lasting less than 10 days without worsening 1
• Mild fever and cough without high-risk features 1

The number needed to harm from antibiotic adverse effects (8) exceeds the number needed to treat for benefit (18) in uncomplicated rhinosinusitis. 1

When Antibiotics ARE Indicated

Reserve antibiotic treatment for acute bacterial rhinosinusitis only when the patient meets one of these three criteria: 1

1. Persistent symptoms for more than 10 days without clinical improvement
2. Severe symptoms including fever >39°C AND purulent nasal discharge or facial pain lasting at least 3 consecutive days
3. "Double sickening": worsening symptoms after initial improvement from a typical viral URI (new-onset fever, headache, or increased nasal discharge after 5 days of initial improvement)

Antibiotic Selection When Indicated

For acute bacterial rhinosinusitis in adolescents:

• First-line: Amoxicillin 45 mg/kg/day divided into two doses (or 40 mg/kg/day divided into three doses) for 7-10 days 2
• If recent antibiotic use (within 4-6 weeks): High-dose amoxicillin 90 mg/kg/day to cover resistant organisms 2
• Alternative for penicillin allergy: Doxycycline (appropriate for age 15) or respiratory fluoroquinolone (levofloxacin, moxifloxacin) 1

The American Academy of Otolaryngology-Head and Neck Surgery actually recommends watchful waiting even for diagnosed bacterial sinusitis, though IDSA guidelines support immediate antibiotics once bacterial criteria are met. 1 Given the favorable risk-benefit profile of observation, consider a 3-day watchful waiting period for mild-to-moderate cases before initiating antibiotics.

Special Consideration: Streptococcal Pharyngitis

If the patient presents with sore throat as the predominant symptom:

• Perform rapid strep test or throat culture 1
• Only treat with antibiotics if positive for Group A Streptococcus 1
• If positive: Amoxicillin 50-75 mg/kg/day in 2 doses for 10 days 2

Red Flags Requiring Urgent Evaluation

Refer for immediate assessment if:

• Signs of respiratory distress (markedly raised respiratory rate, intercostal retractions, breathlessness) 1
• Severe dehydration 1
• Altered consciousness 1
• Signs of septicemia 1
• Clinical deterioration despite appropriate therapy 1

Follow-Up Recommendations

• Reassess at 48-72 hours if antibiotics are prescribed; lack of improvement indicates treatment failure requiring antibiotic change or specialist referral 2
• Educate the patient/family on expected symptom duration (7-10 days), warning signs of complications, and when to return for reevaluation 2
• Avoid routine imaging as it does not distinguish viral from bacterial causes and increases costs 4-fold without improving outcomes 1