Symptomatic Treatment for Upper Respiratory Tract Infections in Healthy Adult Women
For an otherwise healthy adult woman with URTI symptoms, antibiotics should NOT be prescribed, as more than 90% of URTIs are viral in origin. 1
Recommended Symptomatic Medications
For Cough Relief
- Dextromethorphan or codeine can be prescribed for dry, bothersome cough 1, 2
- These antitussives are appropriate when cough is interfering with daily activities or sleep 1
- Do NOT prescribe expectorants, mucolytics, antihistamines alone, or bronchodilators for acute URTI, as these lack evidence of benefit 1
For Pain and Fever
- Acetaminophen, ibuprofen, or naproxen are recommended for pain or fever relief 3
- Ibuprofen is FDA-approved for these symptoms and well-tolerated in most patients 4
For Nasal Congestion
- Decongestants (oral or topical) can provide symptomatic relief for nasal congestion 3
- Antihistamine-decongestant combinations showed significant benefit over placebo in adult studies (p<0.01) 5
What NOT to Prescribe
Antibiotics are explicitly NOT indicated unless specific high-risk features are present 1:
- Systemically very unwell appearance
- Suspected pneumonia (new focal chest signs, dyspnoea, tachypnoea, fever >4 days) 1
- Age >75 years with fever
- Cardiac failure, insulin-dependent diabetes, or serious neurological disorder 1
The evidence is clear that antihistamines alone are ineffective for URTI symptoms in adults 5
Patient Education and Monitoring
Advise the patient to return if:
- Symptoms persist beyond 3 weeks 1
- Fever exceeds 4 days 1
- Dyspnoea develops or worsens 1
- New focal chest signs appear 1
Most URTIs are self-limited and benefit primarily from reassurance, education, and symptomatic home treatment 6
Critical Pitfall to Avoid
The most common error is prescribing antibiotics for acute bronchitis, which leads to more inappropriate antibiotic prescribing than any other URTI syndrome in adults 1. Over 70% of acute bronchitis visits result in antibiotic prescriptions despite being viral in >90% of cases 1. This practice contributes to antibiotic resistance without improving patient outcomes 1.