Antibiotics Are NOT Recommended for Uncomplicated Upper Respiratory Infections
For an uncomplicated URI in an adult without significant comorbidities, antibiotics should not be prescribed—the infection is viral and self-limiting, and antibiotic treatment provides no clinical benefit. 1, 2
Why Antibiotics Are Inappropriate for Uncomplicated URI
Over 80-90% of acute URIs are viral, caused by rhinoviruses, coronaviruses, parainfluenza viruses, RSV, and adenoviruses—none of which respond to antibiotics 1
Antibiotic treatment does not enhance illness resolution in nonspecific upper respiratory tract infections and is explicitly not recommended 2
Most uncomplicated URIs resolve spontaneously within 1-2 weeks without any intervention 1
Purulent nasal discharge does not indicate bacterial infection and does not predict benefit from antibiotics—this is a critical pitfall to avoid 1, 2
When to Consider Antibiotics (Bacterial Complications Only)
Antibiotics should be reserved exclusively for specific bacterial complications, not the URI itself:
Acute Bacterial Rhinosinusitis
Only prescribe antibiotics if symptoms persist >10 days without improvement, indicating possible bacterial superinfection 1, 3
"Double sickening" (worsening after initial improvement at day 5-7) suggests bacterial infection 1
Severe symptoms (fever >39°C with purulent discharge for ≥3 consecutive days) may warrant antibiotics 1, 3
Acute Otitis Media
If otitis media is diagnosed on otoscopic examination, use amoxicillin-clavulanate as first-line therapy for 8-10 days 4
Amoxicillin-clavulanate is superior to plain amoxicillin because 17-34% of H. influenzae and 100% of M. catarrhalis produce beta-lactamase 4
Group A Streptococcal Pharyngitis
- Only prescribe antibiotics with a positive rapid antigen test or culture—do not diagnose clinically without testing 5
Appropriate Management of Uncomplicated URI
Provide symptomatic treatment only: analgesics (acetaminophen or ibuprofen), decongestants, and reassurance about expected duration 4
Educate patients that symptoms typically last up to 2 weeks and that purulent discharge is normal with viral infections 1
Advise follow-up only if symptoms worsen or persist beyond 10 days without improvement 1
Critical Pitfalls to Avoid
Do not prescribe antibiotics based on purulent secretions alone—this is the most common error and does not predict bacterial infection 1, 2
Do not prescribe antibiotics within the first 10 days unless severe symptoms or "double sickening" occur—this represents normal viral course 1
Life-threatening complications of URI are rare, and studies have not demonstrated that antibiotics prevent complications in adults with uncomplicated URI 2
Antibiotic overuse drives resistance—the majority of antibiotics prescribed for acute respiratory infections in adults are unlikely to provide clinical benefit 6