What is the recommended treatment for an adult patient with symptoms of an upper respiratory infection?

Treatment for Upper Respiratory Infection

For an uncomplicated upper respiratory infection (common cold), do not prescribe antibiotics—they provide no benefit and cause more harm than good. 1

Understanding the Diagnosis

Upper respiratory infections are overwhelmingly viral, self-limited illnesses that resolve without antibiotics in 1-2 weeks. 1, 2 The common cold includes symptoms such as:

• Sneezing, rhinorrhea, nasal congestion 1
• Sore throat, cough 1
• Low-grade fever, headache, malaise 1
• General fatigue 2

Antibiotics play no role in preventing complications such as acute bacterial sinusitis, asthma exacerbation, or otitis media. 1

Recommended Treatment Approach

Symptomatic Management Only

The appropriate management strategy is symptomatic therapy alone—antibiotics should not be prescribed because they are ineffective and significantly increase the risk of adverse effects. 1

Effective symptomatic treatments include:

• Combination antihistamine-analgesic-decongestant products: 1 out of 4 patients experiences significant symptom relief 1
• Analgesics (acetaminophen or ibuprofen) for pain and fever 1, 3
• Inhaled ipratropium bromide for rhinorrhea 1, 3
• Nasal decongestants (pseudoephedrine or phenylephrine) for congestion 4
• Zinc supplements (acetate or gluconate): Reduce symptom duration if started within 24 hours of onset, though weigh against adverse effects like nausea and bad taste 1, 4

Treatments to Avoid

Do NOT use the following—they are ineffective:

• Antibiotics 1
• Vitamin C or echinacea 1
• Inhaled corticosteroids 4
• Over-the-counter cough and cold medications in children under 4-6 years 1, 4

When to Consider Bacterial Infection

Reserve antibiotics ONLY if the patient develops acute bacterial rhinosinusitis, which is suspected when: 1

1. Persistent symptoms ≥10 days without improvement 1, 5
2. Severe symptoms (fever >39°C with purulent nasal discharge or facial pain) for ≥3 consecutive days 1, 5
3. "Double sickening": Worsening after initial improvement from a typical viral URI 1, 5

If bacterial sinusitis is confirmed, prescribe amoxicillin-clavulanate as the preferred first-line agent (alternatives: doxycycline or respiratory fluoroquinolone). 1, 5

Patient Education and Follow-Up

Counsel patients that:

• Symptoms can last up to 2 weeks 1
• They should follow up if symptoms worsen or exceed expected recovery time 1
• Antibiotics are not needed and may cause adverse effects 1
• Hand hygiene is the best prevention method for transmission 1, 3

Instruct patients to return if:

• Symptoms persist beyond 3 weeks 1
• Fever exceeds 4 days 1
• Dyspnea worsens 1
• New severe symptoms develop (high fever, facial pain, purulent discharge) 1

Critical Pitfall to Avoid

The most common error is prescribing antibiotics for viral URIs. Despite improvements since the 1990s, antibiotics are still prescribed at 30% of common cold visits, and broad-spectrum agents are used in 61% of cases where antibiotics are given—even though they are unnecessary. 1 This practice drives antibiotic resistance without providing patient benefit, as the number needed to harm (8) exceeds the number needed to treat (18) even in bacterial sinusitis. 1