From the Guidelines
Most upper respiratory tract infections (URIs) do not require antibiotics as they are typically caused by viruses rather than bacteria. Antibiotics should only be prescribed for URIs when there is strong evidence of bacterial infection, such as streptococcal pharyngitis, sinusitis lasting more than 10 days with purulent discharge, or symptoms that worsen after initial improvement.
Key Considerations
- The diagnosis of bacterial infection should be based on stringent and validated clinical criteria, as established through clinical guidelines 1.
- The use of antibiotics is not indicated for viral respiratory infections, and their use can contribute to antibiotic resistance and cause side effects like diarrhea, nausea, and allergic reactions.
- When antibiotics are necessary, first-line options include amoxicillin (500mg three times daily for 5-7 days) for sinusitis or streptococcal pharyngitis, or amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) for more resistant infections.
- For penicillin-allergic patients, alternatives include azithromycin (500mg on day 1, then 250mg daily for 4 days) or doxycycline (100mg twice daily for 5-7 days) 1.
Symptomatic Treatment
- Symptomatic treatment for viral URIs includes rest, hydration, over-the-counter pain relievers, saline nasal sprays, and throat lozenges.
- Patients should seek medical attention if symptoms persist beyond 10 days, fever exceeds 102°F (39°C), or if they experience severe headache, neck stiffness, or difficulty breathing.
Evidence-Based Recommendations
- The principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics, as outlined in the 2013 clinical report by the American Academy of Pediatrics, emphasize the importance of using stringent and validated clinical criteria when diagnosing acute otitis media, acute bacterial sinusitis, and pharyngitis caused by group A Streptococcus (GAS) 1.
- The report also highlights the need to weigh the benefits and harms of antibiotic therapy and to implement judicious prescribing strategies to mitigate overuse of antibiotics for pediatric URIs.
- The use of benzathine penicillin G has been shown to be effective in preventing initial attacks of rheumatic fever and is recommended as a first-line treatment for group A streptococcal pharyngitis 1.
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 To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin for oral suspension and other antibacterial drugs, amoxicillin for oral suspension should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Amoxicillin is indicated for the treatment of Upper Respiratory Tract Infections. The dosage for adults is 750 to 1750 mg/day in divided doses every 8 to 12 hours, and for pediatric patients over 3 months of age, the dosage is 20 to 45 mg/kg/day in divided doses every 8 to 12 hours 2.
From the Research
Upper Respiratory Tract Infections and Antibiotic Use
- Upper respiratory tract infections (URTIs) are a common reason for physician visits and antibiotic prescriptions in the United States 3, 4.
- However, most URTIs are caused by viruses, and antibiotics are often prescribed unnecessarily, leading to adverse events, antibiotic resistance, and increased costs 3, 5.
Conditions That May Require Antibiotics
- Acute otitis media: antibiotics may be indicated in certain cases, such as in children younger than 6 months or with bilateral otitis media 4, 5.
- Group A beta-hemolytic streptococcal pharyngitis: antibiotics are recommended for treatment, with penicillin and amoxicillin as first-line options 6, 7.
- Epiglottitis: antibiotics may be indicated in certain cases 3, 5.
- Acute rhinosinusitis: antibiotics may be considered if symptoms persist or worsen after an initial observation period 4, 5.
Conditions That Do Not Require Antibiotics
- Common cold: antibiotics are not recommended, and treatment should focus on symptom management with over-the-counter medications 3, 4.
- Influenza: antibiotics are not recommended, and treatment should focus on antiviral medications and symptom management 3.
- Laryngitis: antibiotics are not recommended, and treatment should focus on symptom management with over-the-counter medications 3, 5.
- COVID-19: antibiotics are not recommended, and treatment should focus on antiviral medications and symptom management 3.
Antibiotic Selection and Resistance
- Clarithromycin may be a valid treatment option for group A beta-hemolytic streptococcal pharyngitis, although it is not currently recommended as a first-line therapy 6.
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States, making penicillin and amoxicillin preferred first-line options 7.