From the Guidelines
Management of viral respiratory symptoms primarily involves supportive care, with a focus on relieving symptoms and improving quality of life, as antibiotics are ineffective against viral infections 1. The goal of treatment is to alleviate symptoms such as cough, sneezing, rhinorrhea, sore throat, and nasal congestion, which typically peak within 3 days and resolve within 10 to 14 days.
- For fever and pain, analgesics or antipyretic drugs like acetaminophen or ibuprofen can be used, as they provide symptom relief 1.
- Nasal congestion may be relieved with nasal saline, which has been shown to have minor improvements in nasal symptom scores, or with oral decongestants like pseudoephedrine, though their use should be limited to 3-5 days to avoid rebound congestion 1.
- Cough can be managed with cough suppressants like dextromethorphan, although evidence of clinical efficacy is lacking, and decisions regarding their use are largely related to patient and provider preference 1.
- Topical intranasal steroids may have a role in managing viral respiratory symptoms, as they have been shown to relieve facial pain and nasal congestion, although the magnitude of effect is small and the choice of therapy should be based on patient preference 1. It is essential to note that antibiotics are not recommended for treating viral respiratory symptoms, as they are ineffective against viral illnesses and do not provide direct symptom relief 1.
- Patients should be advised to seek medical attention if they experience high fever, difficulty breathing, chest pain, severe headache, confusion, or symptoms persisting beyond 10-14 days, as these may indicate complications or bacterial superinfection requiring additional treatment.
From the FDA Drug Label
Instruct patients to begin treatment with oseltamivir phosphate for oral suspension as soon as possible from the first appearance of flu symptoms, within 48 hours of onset of symptoms. Instruct patients to take any missed doses as soon as they remember, except if it is near the next scheduled dose (within 2 hours), and then continue to take oseltamivir phosphate for oral suspension at the usual times.
The patient instructions for viral respiratory symptoms are to start treatment with oseltamivir phosphate as soon as possible, within 48 hours of symptom onset. Patients should take any missed doses as soon as remembered, unless near the next scheduled dose.
- Key points:
- Start treatment within 48 hours of symptom onset
- Take missed doses as soon as remembered, unless near the next scheduled dose
- Continue taking oseltamivir phosphate at the usual times 2
From the Research
Management Options for Viral Respiratory Symptoms
- The management of viral respiratory symptoms can be approached through various methods, including medication and self-care measures 3, 4, 5, 6.
- For patients with influenza, treatment with one of four approved anti-influenza drugs may be considered if the patient presents within 48 hours of symptom onset, with the benefit of treatment being greatest when antiviral therapy is started within 24 hours of symptom onset 3.
- Annual influenza vaccination is recommended for all people six months and older who do not have contraindications 3.
- For the common cold, informing patients about the self-limited nature of the illness can help manage expectations, limit antibiotic use, and avoid over-the-counter purchases that may not help 4.
- Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough 4.
- Lower-quality evidence suggests that Lactobacillus casei may be beneficial in older adults, while the only established safe and effective treatments for children are acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils 4.
- A fixed-dose combination of paracetamol, chlorphenamine, and phenylephrine was found to be safe and effective in the symptomatic treatment of the common cold or flu-like syndrome in adults 5.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be beneficial in reducing fever and sore throat in both adults and children, although the evidence for their use in reducing cough is uncertain 6.
Medication Options
- Anti-influenza drugs, such as oseltamivir, zanamivir, amantadine, and rimantadine, may be used to treat influenza 3.
- Over-the-counter medications, such as analgesics, decongestants, and antihistamines, may be used to relieve symptoms of the common cold 4.
- NSAIDs, such as ibuprofen and naproxen, may be used to reduce fever and relieve sore throat 6.
- Acetylcysteine, honey, nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils may be used to treat cold symptoms in children 4.