What are the discharge instructions for a patient with an upper respiratory infection (URI)?

Discharge Instructions for Upper Respiratory Infection (URI)

Patients with upper respiratory infections should be managed with supportive care including adequate hydration, rest, and targeted symptom relief rather than antibiotics, as most URIs are viral in nature and antibiotics provide no clinical benefit while increasing the risk of adverse events. 1

Symptom Management

Pain and Fever Relief

• Use acetaminophen or NSAIDs (ibuprofen, naproxen) for pain or fever as needed 1, 2
• Antipyretics recommended for fever >38.5°C or for symptom relief 1
• Both acetaminophen and ibuprofen are equally effective for fever reduction 1

Nasal Congestion

• Nasal saline irrigation is safe and provides modest symptom improvement 1
• Topical decongestants can provide short-term relief but should not be used for more than 3-5 days to avoid rebound congestion 1
• Oral decongestants may provide symptomatic relief if no contraindications exist 1

Cough Management

• For adults with distressing cough, consider honey as first-line treatment 1
• For persistent distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
• The American College of Chest Physicians does not recommend central cough suppressants (codeine, dextromethorphan) for URI-related cough due to limited efficacy 1

Hydration

• Maintain regular fluid intake of approximately 2 liters per day to avoid dehydration 1

Medication Warnings

• Antibiotics should not be used for viral URIs as they provide no clinical benefit, contribute to antibiotic resistance, and increase risk of adverse events 1, 3
• Over-the-counter combination cold medications are not recommended unless they contain an older antihistamine-decongestant 1
• Albuterol is not recommended for cough not due to asthma 1

When to Seek Medical Attention

• Return for medical evaluation if:
  • Symptoms persist beyond 10 days without improvement 1
  • Symptoms worsen after initial improvement 1
  • Severe symptoms develop 1
  • Fever >38°C persists for more than 48 hours 4
  • Breathing becomes difficult or worsens 4
  • New symptoms develop that suggest bacterial infection 1

Prevention of Transmission

• Practice good hand hygiene to prevent transmission to others 1
• Consider wearing a mask when around others, especially during outbreaks 1
• Limit close contact with others while symptomatic 1

Expected Recovery

• Most URIs are viral and will improve in 7-10 days with symptomatic treatment 5
• Symptoms typically peak within 2-3 days and gradually improve thereafter

Special Considerations

• Elderly patients require closer monitoring for complications 1
• Children under 4 years should avoid over-the-counter cold medications 1
• Athletes may return to activity gradually as symptoms improve, but should avoid intense training during acute illness 5

Remember that most URIs are self-limiting viral infections that will resolve with supportive care. Antibiotics should only be considered if there is strong evidence of bacterial infection such as confirmed streptococcal pharyngitis or acute bacterial sinusitis 1, 3.