From the Guidelines
To treat a URI, most patients should be managed with supportive care, including analgesics for pain and antipyretics for fever, as well as additional therapies such as systemic or topical decongestants, saline nasal irrigation, and intranasal corticosteroids tailored to the patient's symptoms. Antibiotic treatment should be reserved for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1. The use of antibiotics for URI is generally not recommended due to the low likelihood of bacterial infection and the potential for adverse effects, with a number needed to harm of 8 for every 18 patients treated 1.
Some key points to consider when treating a URI include:
- The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with persistent illness, worsening course, or severe onset 1.
- Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis, but its use should be guided by clinical criteria and not empirical prescribing 1.
- Clinicians should reassess initial management if there is either a caregiver report of worsening or failure to improve within 72 hours of initial management 1.
- The careful application of clinical criteria has the potential to mitigate overuse of antibiotics for pediatric URIs and reduce the risk of antibiotic resistance 1.
Overall, the treatment of URI should focus on supportive care and symptom management, with antibiotic treatment reserved for specific cases where the benefits outweigh the risks.
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.
Amoxicillin can be used to treat Upper Respiratory Tract Infections. The recommended dosage is:
- Adults: 750 to 1750 mg/day in divided doses every 8 to 12 hours
- Pediatric Patients over 3 Months of Age: 20 to 45 mg/kg/day in divided doses every 8 to 12 hours 2
From the Research
Treatment Options for Upper Respiratory Tract Infections (URTI)
- The common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM) are types of URTIs, which can be treated with symptom management using over-the-counter drugs 3.
- For viral URTIs, antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days 3.
- Medications such as acetaminophen, ibuprofen, or naproxen can be used to treat pain or fever, while antihistamines and/or decongestants can be used to treat congestion and runny nose 4.
- A combination of paracetamol and pseudoephedrine has been shown to be effective in treating nasal congestion and pain-related symptoms in URTI 5.
Management and Prevention of URTI
- Early intervention is crucial in managing acute URTI, as it can reduce symptom severity and prevent viral transmission 6.
- Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI, creating a barrier that can trap virus particles and deliver broad-spectrum activity against various pathogens 6.
- Informing patients about the self-limited nature of the common cold can help manage expectations and limit antibiotic use 7.
- Good hand hygiene is essential in preventing the transmission of cold viruses 7.
Treatment Guidelines for Specific Age Groups
- For children younger than 6 years, over-the-counter cold medications should not be used, and treatments such as acetylcysteine, honey, nasal saline irrigation, and topical application of ointment containing camphor, menthol, and eucalyptus oils are recommended 7.
- For adults, treatments with proven effectiveness for cold symptoms include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough 7.