Respiratory tract infections (RTIs) are among the most common illnesses affecting the upper or lower airways. They may be caused by viruses, bacteria, or occasionally fungi. While most upper respiratory infections are mild and viral, lower respiratory infections can be serious and require urgent medical care. Proper diagnosis and rational use of antibiotics are essential to prevent complications and antimicrobial resistance.
Types of Respiratory Tract Infections
Upper Respiratory Tract Infections (URTI)
- Common cold
- Sinusitis
- Pharyngitis
- Tonsillitis
- Laryngitis
Most URTIs are viral and do not require antibiotics.
Lower Respiratory Tract Infections (LRTI)
- Acute bronchitis
- Chronic obstructive pulmonary disease (COPD) exacerbation
- Pneumonia
Common Causes
Viral Causes
- Rhinovirus
- Influenza virus
- Respiratory syncytial virus (RSV)
Bacterial Causes
- Streptococcus pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Staphylococcus aureus
Symptoms
- Cough (dry or productive)
- Fever and chills
- Sore throat
- Nasal congestion
- Breathlessness (LRTI)
- Chest pain (pneumonia)
- Fatigue
Diagnosis
Diagnosis depends on clinical symptoms and may require tests for severe or complicated cases.
- Physical examination
- Chest X-ray (for suspected pneumonia)
- Complete blood count (CBC)
- Sputum culture
- Rapid influenza testing (if needed)
Treatment of Upper Respiratory Tract Infections
Most URTIs are viral; therefore, antibiotics are usually not required.
- Rest and hydration
- Analgesics such as paracetamol
- Decongestants or antihistamines if needed
- Salt water gargle for sore throat
Antibiotics are needed only when bacterial infection is confirmed.
Treatment of Lower Respiratory Tract Infections
Acute Bronchitis
Mostly viral; antibiotics not recommended unless bacterial infection is suspected.
COPD Exacerbation
- Bronchodilators
- Oral or IV steroids
- Antibiotics only if purulent sputum or severe symptoms
Pneumonia
Pneumonia requires antibiotic therapy. Empirical treatment depends on severity and whether the infection is community-acquired (CAP) or hospital-acquired (HAP).
Community-Acquired Pneumonia (CAP)
- Mild: Amoxicillin or doxycycline
- Moderate: Amoxicillin–clavulanic acid + macrolide
- Severe: IV ceftriaxone + azithromycin
Hospital-Acquired Pneumonia (HAP)
- Cover gram-negative bacteria and MRSA
- Piperacillin–tazobactam, meropenem, or cefepime
- Add vancomycin if MRSA suspected
Supportive Management
- Oxygen therapy for hypoxia
- Nebulization (salbutamol or ipratropium)
- Hydration
- Antipyretics for fever
When to Hospitalize?
- Respiratory distress
- Low oxygen levels
- Severe chest X-ray involvement
- Sepsis or shock
- High-risk patients (elderly, children, immunocompromised)
Prevention
- Vaccination: influenza, pneumococcal vaccines
- Hand hygiene
- Avoid smoking
- Improve ventilation
Patient Counseling
- Complete antibiotic course if prescribed
- Do not use leftover antibiotics
- Use steam inhalation for congestion
- Seek help if difficulty in breathing or persistent fever
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