From the Guidelines
Upper respiratory tract infections (URTIs) are typically viral infections affecting the nose, throat, and sinuses, and treatment primarily involves managing symptoms with rest, hydration, and over-the-counter medications, with antibiotics only used if a bacterial infection is confirmed. The management of URTIs should focus on alleviating symptoms and preventing complications, rather than solely treating the infection.
Symptoms and Diagnosis
URTIs can present with a range of symptoms, including nasal congestion, cough, sore throat, and fever. Diagnosis is typically based on clinical presentation, as radiographic imaging and laboratory tests are not usually necessary for uncomplicated cases 1.
Treatment
For pain and fever, acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can help. Saline nasal sprays and humidifiers relieve congestion, while lozenges or warm salt water gargles soothe sore throats. Decongestants like pseudoephedrine (30-60mg every 4-6 hours) can temporarily reduce nasal congestion but should be avoided in those with high blood pressure.
Antibiotic Use
Antibiotics are ineffective against viral infections and should only be used if a bacterial infection is confirmed, such as in cases of acute bacterial sinusitis (ABRS) or other complications 1. The decision to prescribe antibiotics should be based on clinical criteria, including the duration and severity of symptoms, and the presence of specific signs and symptoms, such as facial pain, purulent nasal discharge, or fever greater than 39°C 1.
Prevention
Prevention includes regular handwashing, avoiding close contact with sick individuals, and not sharing personal items. By following these guidelines and using antibiotics judiciously, we can reduce the risk of complications and the development of antibiotic-resistant bacteria.
Some key points to consider in the management of URTIs include:
- Most URTIs resolve within 7-10 days without antibiotics
- Antibiotics should only be used if a bacterial infection is confirmed
- Symptomatic treatment with rest, hydration, and over-the-counter medications is usually sufficient
- Prevention measures, such as handwashing and avoiding close contact with sick individuals, can help reduce the spread of infection.
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.
Upper Respiratory Tract Infections (URTI) can be treated with amoxicillin for oral suspension, as it is indicated for the treatment of infections due to susceptible isolates of certain bacteria, including Streptococcus species, Streptococcus pneumoniae, Staphylococcus species, and Haemophilus influenzae 2.
From the Research
Definition and Management of URTI
- Upper respiratory tract infection (URTI) is an illness caused by an acute infection by viruses or bacteria of the nose, sinuses, pharynx, and larynx 3.
- URTIs include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM) 4.
- The current acute URTI management strategies aim toward symptom alleviation and prevention of URTI virus transmission 3.
Treatment and Prevention
- Recommended therapy for the common cold involves symptom management with over-the-counter drugs 4.
- Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days 4.
- A combination of paracetamol and pseudoephedrine has been shown to be effective in treating nasal congestion and pain-related symptoms in URTI 5.
- Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI, creating a barrier that can trap virus particles and delivering broad spectrum activity against a wide variety of pathogens 3.
Antibiotic Use
- Antibiotics should not be used for the common cold, influenza, COVID-19, or laryngitis 6.
- Evidence supports antibiotic use in most cases of acute otitis media, group A beta-hemolytic streptococcal pharyngitis, and epiglottitis and in a limited percentage of acute rhinosinusitis cases 6.
- Family physicians must take an evidence-based, judicious approach to the use of antibiotics in patients with upper respiratory tract infections to avoid adverse events, antibiotic resistance, and unnecessary costs 6.