What medications are recommended for an otherwise healthy female patient presenting with Upper Respiratory Tract Infection (URTI) symptoms?

Symptomatic Treatment for Uncomplicated Upper Respiratory Tract Infection

For an otherwise healthy female patient with URTI symptoms, antibiotics should NOT be prescribed, and treatment should focus on symptomatic relief with acetaminophen or ibuprofen for pain/fever, and decongestants or antihistamines for nasal congestion. 1, 2

Why Antibiotics Are Not Indicated

• Most URTIs are viral infections that do not respond to antibiotics 3, 2
• The European Position Paper on Rhinosinusitis explicitly identifies URTIs as acute, self-limiting conditions where antibiotic use is inappropriate and contributes to antimicrobial resistance 1
• Antibiotics should only be considered in URTIs when there are features suggestive of serious bacterial complications, pre-existing comorbidities, or specific high-risk criteria 4

Recommended Symptomatic Medications

For Pain and Fever

• Acetaminophen (dose per standard adult dosing guidelines) 3
• Ibuprofen (dose per standard adult dosing guidelines) 3
• Naproxen (dose per standard adult dosing guidelines) 3

For Nasal Congestion and Rhinorrhea

• Antihistamines for runny nose 3
• Decongestants for nasal congestion 3

When to Consider Antibiotics (Red Flags)

Antibiotics may be warranted only if the patient develops specific complications or meets high-risk criteria 2, 4:

• Systemically very unwell with features of serious illness 4
• Age >65 years with acute cough PLUS two or more of: hospitalization in previous year, diabetes, heart failure history, current oral glucocorticoid use 4
• Age >80 years with acute cough PLUS one or more of the above risk factors 4
• Specific bacterial complications such as group A streptococcal pharyngitis (requires Centor criteria ≥3), acute otitis media, or epiglottitis 2
• Persistent rhinosinusitis beyond 10 days without improvement 2

Patient Education and Reassurance

• Most patients attending primary care with URTI symptoms seek reassurance (51%), information (49%), and further examination (53%) rather than antibiotics (only 34% expect antibiotics) 5
• Provide clear education that URTIs are self-limiting viral infections that typically resolve within 7-10 days without antibiotics 3, 4
• Reassure the patient that symptomatic treatment is appropriate and that antibiotics would not help and could cause harm through side effects and resistance 1, 2

Critical Pitfalls to Avoid

• Do not prescribe antibiotics for uncomplicated viral URTIs, as this increases antimicrobial resistance, masks diagnoses, and risks adverse effects including allergic reactions 1
• Do not confuse URTI with lower respiratory tract infection (pneumonia), which would require different management including possible antibiotics 1
• Avoid non-prescription antibiotic dispensing, which is a major contributor to inappropriate antibiotic use globally, particularly with amoxicillin and azithromycin being inappropriately dispensed for URTIs 1