What is the recommended antibiotic for an upper respiratory tract infection (URTI)?

From the Guidelines

Antibiotics are generally not recommended for most upper respiratory infections (URIs) as they are typically caused by viruses, not bacteria. For viral URIs, supportive care including rest, hydration, and over-the-counter medications for symptom relief is the appropriate approach. However, if a bacterial infection is suspected, such as in bacterial sinusitis, streptococcal pharyngitis, or bacterial pneumonia, amoxicillin is often the first-line antibiotic choice, as recommended by the American College of Physicians and the Centers for Disease Control and Prevention 1. For adults, typical dosing is 500 mg three times daily or 875 mg twice daily for 5-10 days depending on the specific condition. For patients with penicillin allergy, azithromycin (500 mg on day 1, then 250 mg daily for 4 days) or doxycycline (100 mg twice daily for 5-10 days) may be used, as suggested by the principles of appropriate antibiotic use for nonspecific upper respiratory tract infections 1. It's essential to complete the full course of antibiotics even if symptoms improve, as unnecessary antibiotic use contributes to antibiotic resistance and can cause side effects like diarrhea, nausea, and allergic reactions. A healthcare provider should evaluate persistent symptoms (lasting more than 10-14 days), high fever, severe pain, or worsening symptoms after initial improvement, as these may indicate a bacterial infection requiring antibiotic treatment, according to the guidelines for appropriate antibiotic use for acute respiratory tract infection in adults 1. Some key points to consider when prescribing antibiotics for upper respiratory infections include:

• Using clinical signs and symptoms to differentiate bacterial from viral causes
• Reserving antibiotic treatment for patients with persistent symptoms or severe symptoms
• Choosing the appropriate antibiotic based on the suspected bacterial cause and patient factors, such as penicillin allergy
• Completing the full course of antibiotics to ensure effective treatment and prevent resistance. In the case of group A streptococcal pharyngitis, penicillin V is the recommended antibiotic, with a dosage of 250 mg two to three times daily for 10 days, as outlined in the practice guidelines for the diagnosis and management of group A streptococcal pharyngitis 1. Overall, the use of antibiotics for upper respiratory infections should be guided by evidence-based principles and clinical judgment to ensure effective treatment and minimize unnecessary antibiotic use.

From the FDA Drug Label

AMOXICILLIN for oral suspension is a penicillin-class antibacterial indicated for treatment of infections due to susceptible strains of designated microorganisms Upper Respiratory Tract Infections of the Ear, Nose, and Throat In Adults, 750 to 1750 mg/day in divided doses every 8 to 12 hours In Pediatric Patients over 3 Months of Age, 20 to 45 mg/kg/day in divided doses every 8 to 12 hours.

The antibiotic to use for upper respiratory infection is amoxicillin. The dosage for adults is 750 to 1750 mg/day in divided doses every 8 to 12 hours, and for pediatric patients over 3 months of age, it is 20 to 45 mg/kg/day in divided doses every 8 to 12 hours 2.

From the Research

Antibiotic Treatment for Upper Respiratory Infections

• The choice of antibiotic for upper respiratory infections depends on the specific condition and causative pathogen 3, 4, 5.
• For streptococcal pharyngitis, penicillin V and amoxicillin are recommended as first-line antibiotics, with a course of 10 days 3, 6.
• In children, amoxicillin is the drug of choice for acute otitis media (AOM) due to low penicillin resistance rates for Streptococcus pneumoniae 3.
• For acute bacterial sinusitis, amoxicillin is also the recommended antibiotic 3, 5.
• The use of antibiotics for upper respiratory tract infections is discretionary rather than prohibited or mandatory, and should be based on clinical judgment and patient-specific factors 5.

Specific Conditions and Antibiotic Use

• Acute pharyngitis: antibiotics should only be prescribed if test or culture results are positive for streptococcal infection 4, 6.
• Acute otitis media (AOM): antibiotics are recommended for children under 6 months, children with bilateral AOM, and those with otorrhea or severe illness 3, 4.
• Rhinosinusitis: antibiotics are not recommended unless symptoms worsen or do not improve after 7-10 days 4, 5.
• Common cold: antibiotics are not indicated, and treatment should focus on symptom management with over-the-counter drugs 4, 7, 5.