What is the treatment for Upper Respiratory Tract Infection (URTI)?

Treatment of Upper Respiratory Tract Infections (URTI)

Antibiotics should NOT be prescribed for uncomplicated viral URTIs, as they are ineffective against viral illness, do not prevent progression to lower respiratory tract infections, and contribute to antibiotic resistance. 1, 2, 3

Primary Management: Symptomatic Treatment Only

Most URTIs are viral and self-limiting, resolving within 1-3 weeks without specific intervention. 2, 3 The cornerstone of management is symptomatic relief:

First-Line Symptomatic Treatments

• Analgesics/Antipyretics: Acetaminophen or ibuprofen for pain, fever, and inflammation 2, 3, 4
• Adequate hydration and rest as supportive measures for recovery 2, 3
• Nasal saline irrigation for persistent nasal congestion, providing minor symptom improvement 2, 3
• Cough suppressants: Dextromethorphan 5 or codeine for bothersome dry cough 2, 3
• Oral decongestants (e.g., pseudoephedrine 6) may provide symptomatic relief if no contraindications exist 3
• Topical decongestants can be used but should NOT exceed 3-5 days to avoid rebound congestion 3

What NOT to Prescribe

• Antibiotics for uncomplicated viral URTIs—they are ineffective and will not prevent lower respiratory tract infections 1, 2, 3
• Mucolytics, expectorants, or bronchodilators—these have not shown benefit in uncomplicated viral URTIs 2
• Homeopathic substances—not recommended as they lack evidence 1

When Antibiotics ARE Indicated

Antibiotics should only be considered for bacterial superinfection or specific bacterial diagnoses:

Signs Suggesting Bacterial Superinfection

• High fever (>38.5°C) persisting beyond 3 days with bothersome cough—consider amoxicillin 2, 3
• Acute bacterial rhinosinusitis (symptoms >10 days, temperature >39°C, or worsening after initial improvement):
  • First-line: Amoxicillin-clavulanate, second-generation or third-generation oral cephalosporins 2
  • For beta-lactam allergies: Pristinamycin or macrolides 2
  • Treatment duration: 7-10 days 2
• Streptococcal pharyngitis (only if test/culture positive): 10-day treatment course 2, 7
• Acute otitis media: Amoxicillin 80-100 mg/kg/day in three daily doses for children <30 kg 2

High-Risk Patients Requiring Closer Monitoring

Consider antibiotics in patients with:

• Age ≥65 years with fever 2, 3
• Chronic cardiac or pulmonary diseases 2, 3
• Diabetes mellitus (especially insulin-dependent) 2, 3
• Chronic renal diseases 2, 3
• Serious neurological disorders 3

Follow-Up and Red Flags

Advise patients to return if:

• Symptoms persist beyond 3 weeks 2, 3
• Fever exceeds 4 days 2, 3
• Dyspnea worsens 2, 3
• Patient's condition deteriorates or consciousness decreases 2, 3

Consider chest imaging if symptoms persist or worsen to rule out parenchymal lung disease 2, 8

Special Considerations

• First-generation antihistamine/decongestant combinations (e.g., brompheniramine with pseudoephedrine) can be effective for cough associated with post-nasal drip from viral URTI 1
• NSAIDs (e.g., naproxen) may decrease cough, headache, malaise, and myalgia by reducing inflammation 1
• Antiviral treatments should only be considered in high-risk patients with typical influenza symptoms present for <2 days during a known influenza epidemic 3
• Influenza vaccination should be given yearly to high-risk groups to prevent influenza-associated URTIs 1, 3

Common Pitfalls to Avoid

• Do NOT prescribe antibiotics empirically for viral URTIs—this contributes to antibiotic resistance without clinical benefit 1, 2, 3
• Do NOT use antibiotics to "prevent" lower respiratory tract infections—this approach has been proven ineffective 1
• Avoid OTC cold medications in children younger than 6 years per FDA guidance 7
• Recognize that discolored nasal discharge alone does NOT indicate bacterial infection—it is simply a sign of inflammation 3