Can Rhinovirus infection lead to secondary bacterial infection?

From the Guidelines

Rhinovirus infections can lead to bacterial infections, but this occurs in only 0.5% to 2.0% of cases, and symptoms such as duration, illness pattern, and severity can help differentiate between viral and bacterial infections. Rhinoviruses primarily cause the common cold, affecting the upper respiratory tract. While most rhinovirus infections resolve on their own within 7-10 days, they can sometimes create conditions that allow bacteria to establish secondary infections 1. This happens because the viral infection damages the protective lining of the respiratory tract, impairs normal mucus clearance, and alters the local immune response. Common secondary bacterial infections following rhinovirus include sinusitis, otitis media (ear infection), and occasionally bronchitis or pneumonia.

Some key points to consider in managing rhinovirus infections and potential secondary bacterial infections include:

• Nasal purulence alone does not indicate a bacterial infection; discolored nasal discharge is a sign of inflammation and is not specific for infection 1.
• Management of viral rhinosinusitis is primarily directed toward relief of symptoms, and antibiotics are not recommended for treating viral illness since they are ineffective for viral illness and do not provide direct symptom relief 1.
• Palliative medications—such as analgesics, anti-inflammatory agents, nasal saline, decongestants, antihistamines, mucolytics, cough suppressants, and topical or oral corticosteroids—may be used alone or in varying combinations for symptom relief 1.
• People with underlying conditions like asthma, COPD, or compromised immune systems are at higher risk for secondary bacterial infections following rhinovirus infections 1.
• If cold symptoms worsen after initially improving, last longer than 10-14 days, or if you develop new symptoms like fever, severe headache, facial pain, or colored discharge, these may indicate a secondary bacterial infection requiring medical attention 1.
• Antibiotics are not effective against the initial viral infection but may be necessary if a bacterial infection develops 1.

From the Research

Rhinovirus and Bacterial Infection

• Rhinovirus is a common cause of upper respiratory tract infections, including the common cold 2.
• While rhinovirus itself is a viral infection, it can lead to secondary bacterial infections, such as acute bacterial rhinosinusitis (ABRS) 3, 4.
• ABRS is typically caused by bacteria such as Streptococcus pneumoniae or Haemophilus influenzae 3.
• The use of antibiotics, such as amoxicillin/clavulanate, is often prescribed to treat ABRS 3, 4, 5, 6.

Mechanism of Rhinovirus-Induced Cough

• The exact mechanism of how rhinovirus causes cough is not fully understood, but several theories have been proposed, including physical disruption of the epithelial lining, excess mucus production, and an inflammatory response 2.
• Neuronal modulation is also thought to play a role in potentiating cough long after the original stimulus has been cleared 2.

Treatment of Acute Bacterial Rhino Sinusitis

• Ceftriaxone and amoxicillin/clavulanic acid are two antibiotics that have been compared for the treatment of acute bacterial rhinosinusitis 5.
• Ceftriaxone was found to be more effective than amoxicillin/clavulanic acid in one study 5.
• Amoxicillin/clavulanic acid has been shown to be effective in treating ABRS, with tissue and serum distribution studies demonstrating that the antibiotic reaches effective concentrations in the sinusal mucosa 3, 6.