What is the best treatment for viral rhinopharyngitis?

From the Guidelines

The best treatment for viral rhinopharyngitis is supportive care, focusing on symptom relief with medications such as analgesics, anti-inflammatory agents, nasal saline, and decongestants, as antibiotics are ineffective for viral illness. The management of viral rhinopharyngitis is primarily directed toward relief of symptoms, as it is a self-limited disease characterized by cough, sneezing, rhinorrhea, sore throat, and nasal congestion 1.

Symptom Relief

Symptoms in acute viral rhinopharyngitis typically peak within 3 days then gradually decline and resolve within 10 to 14 days. Palliative medications—such as analgesics (e.g., acetaminophen or ibuprofen), 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.

• Analgesics or antipyretic drugs (acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory agents) may be given for pain or fever.
• Nasal saline may be palliative and cleansing with low risk of adverse reactions, with a Cochrane review reporting minor improvements in nasal symptom scores with the use of nasal saline in both physiologic and hypertonic concentrations 1.
• Oral decongestants may provide symptomatic relief and should be considered barring any medical contraindications, such as hypertension or anxiety.
• Topical intranasal steroids may have a role in managing viral rhinopharyngitis, even though they do not have a Food and Drug Administration (FDA) indication for this purpose, with a systematic review finding that topical nasal steroids relieved facial pain and nasal congestion in patients with rhinitis and acute sinusitis 1.

Avoiding Unnecessary Antibiotics

Antibiotics are not recommended for treating viral rhinopharyngitis since antibiotics are ineffective for viral illness and do not provide direct symptom relief 1. The clinical emphasis on duration, illness pattern, and severity of symptoms can help to differentiate between viral vs bacterial infection, with secondary bacterial infection believed to complicate only 0.5% to 2.0% of viral rhinopharyngitis events 1.

Patient Care

Patients should be advised to use supportive measures such as saline nasal sprays, adequate hydration, and rest, which are beneficial in managing symptoms. Zinc lozenges started within 24 hours of symptom onset may also be considered to potentially reduce the duration of symptoms. Patients with underlying conditions like asthma or COPD should monitor symptoms closely and seek medical attention if respiratory symptoms worsen.

From the FDA Drug Label

Uses temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants • the impulse to cough to help you get to sleep The FDA drug label does not answer the question.

From the Research

Treatment Options for Viral Rhinopharyngitis

• The treatment for viral rhinopharyngitis often focuses on alleviating symptoms, as the condition is caused by a virus and does not respond to antibiotics 2.
• Anti-inflammatory agents, such as piroxicam, have been shown to provide significant improvement in symptoms, including nasal obstruction, discharge, hoarseness, sore throat, headache, and dysphagia 3.
• Antiviral therapy may be appropriate, depending on the causative virus, and may involve the use of interferon alpha in combination with anti-inflammatory medication 2.
• Interferon-based medicines, such as viferon gel, have been found to be effective in reducing the duration of the disease and preventing bacterial complications when applied locally 4.

Additional Therapies

• Hyaluronic acid (HA) has been proposed as an ancillary treatment in children with bacterial acute rhinopharyngitis, and has been shown to improve the efficacy of topical antibiotic therapy 5.
• The use of HA in combination with antibiotics has been found to induce a greater effect on symptom perception, neutrophil count, and bacteria count than antibiotic treatment alone 5.

Considerations

• The treatment of viral rhinopharyngitis should be guided by the severity of symptoms and the presence of any underlying conditions, such as adenoid hypertrophy or allergy 6.
• Adenoidectomy and/or tympanostomy tubes may be indicated in the treatment of recurrent acute otitis media, which is a common complication of rhinopharyngitis 6.