Upper respiratory tract infection medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Upper respiratory infections, commonly referred to the acronym URI or URTI, is the illness caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx. In the United States, this represents approximately one billion acute upper respiratory illnesses annually.

Medical Therapy

Judicious use of antibiotics can decrease unnecessary adverse effects of antibiotics as well as out-of-pocket costs to the patient. But more important, decreased antibiotic usage will prevent development of drug resistant bacteria, which is now a growing problem in the world. International, as well as local US health agencies, have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses [2]

Some have advocated a delayed antibiotic approach to treating URIs which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. Most studies show no difference in improvement of symptoms between those treated with antibiotics right away and those with delayed prescriptions. Most studies also show no difference in patient satisfaction, patient complications, symptoms between delayed and no antibiotics. It should be noted that a strategy of "no antibiotics" results in even less antibiotic use than a strategy of "delayed antibiotics". Until more effective treatments are available to treat the common respiratory viruses responsible for the majority of cases, treatment of URIs with rest, increased fluids, and symptomatic care with over-the-counter medications will remain the treatment of choice. However, in certain higher risk patients with underlying lung disease, such as chronic obstructive pulmonary disease (COPD), evidence does exist to support the treatment of URIs with antibiotics to shorten the course of illness and decrease treatment failure.

The use of Vitamin C in the prevention and treatment of upper respiratory infections has been suggested since the initial isolation of vitamin C in the 1930s. Several studies have failed to demonstrate that vitamin C supplementation reduces the incidence of colds in the normal healthy population, indicating that routine large dose prophylaxis with Vitamin C is not beneficial in widespread community usage. Some evidence exists to indicate that it could be justified in persons exposed to brief periods of severe physical exercise and/or cold environments. The evidence does not support the use of Vitamin C at the onset of colds as effective therapy.

Treatment options

• Treatment depends on the underlying cause. Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.
• There is no evidence to support the age-old advice to rest when you are sick with an upper respiratory illness. Moderate exercise in sedentary subjects with a URI has been shown to have no effect on the overall severity and duration of the illness.
• Getting plenty of sleep
• Increasing fluid intake
• Antibiotics

Judicious use of antibiotics can decrease unnecessary adverse effects of antibiotics as well as out-of-pocket costs to the patient. But more importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteria, which is now a growing problem in the world. Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common upper respiratory tract infections because antibiotic usage does not significantly reduce recovery time for these viral illnesses.

• Decongestants
• Alternative medicine
  • The use of Vitamin C

References

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