From the Guidelines
Acute nasopharyngitis and upper respiratory infection (URI) are distinct conditions, with acute nasopharyngitis referring specifically to inflammation of the nasopharynx, while URI is a broader term encompassing infections of any part of the upper respiratory tract. The key difference between the two conditions lies in their scope and the areas of the respiratory tract they affect. Acute nasopharyngitis, commonly known as the common cold, focuses on the nasal passages and throat, whereas URI includes infections of the nose, sinuses, pharynx, larynx, and trachea. Both conditions are typically viral in origin, with rhinoviruses being the most common cause, and share similar symptoms including nasal congestion, runny nose, sore throat, cough, and mild fever 1.
Symptoms and Treatment
Treatment for both conditions is primarily supportive, including:
- Rest
- Adequate hydration
- Over-the-counter analgesics like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (200-400mg every 6-8 hours) for pain and fever
- Decongestants such as pseudoephedrine (30-60mg every 4-6 hours) for nasal congestion Antibiotics are not indicated unless there is evidence of bacterial infection, which is uncommon in uncomplicated cases 1.
Clinical Distinction
The distinction between acute nasopharyngitis and URI matters clinically because certain URIs like sinusitis or laryngitis may require different management approaches than simple nasopharyngitis. However, all typically resolve within 7-10 days with supportive care. It's crucial to differentiate acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis (ARS) caused by viral upper respiratory infections to prevent unnecessary treatment with antibiotics and to avoid ordering unnecessary diagnostic tests, thus controlling costs and improving quality of care 1.
Management Approach
The management approach should prioritize supportive care and reserve antibiotics for cases with clear evidence of bacterial infection, following guidelines that emphasize the importance of distinguishing between viral and bacterial causes of upper respiratory infections to prevent the overuse of antibiotics and reduce the risk of antibiotic resistance 1.
From the Research
Definition and Causes
- Acute nasopharyngitis, also known as the common cold, is a viral infection that affects the upper respiratory tract 2.
- Upper respiratory infection (URI) is a broader term that encompasses various infections, including viral rhinitis, sore throat, and sinusitis, which can be caused by either viruses or bacteria 2.
Symptoms and Diagnosis
- The symptoms of acute nasopharyngitis and URI can be similar, including congestion, runny nose, and sore throat 2.
- However, the diagnosis of acute nasopharyngitis is typically based on the presence of viral symptoms, while URI diagnosis may involve additional tests to determine the cause of the infection 3.
Treatment and Management
- Antibiotics are not effective against viral infections, such as acute nasopharyngitis, and should only be used to treat bacterial infections 4, 3, 5.
- The treatment of URI depends on the underlying cause, with antibiotics being prescribed for bacterial infections, such as streptococcal pharyngitis or acute otitis media 3, 5.
- For viral URIs, treatment is focused on relieving symptoms, such as using acetaminophen, ibuprofen, or antihistamines 2.
Antibiotic Use and Resistance
- The overuse of antibiotics for URIs has contributed to antibiotic resistance, making it essential to use antibiotics judiciously and only when necessary 4, 3, 5.
- Studies have shown that the antibacterial prescription rate for acute upper respiratory tract infections is high, with a significant proportion of prescriptions being unnecessary 6.