What is the guideline for managing viral Upper Respiratory Tract Infections (URTI)?

Management of Viral Upper Respiratory Tract Infections (URTIs)

Viral upper respiratory tract infections should be managed with symptomatic treatment only, as antibiotics are not recommended for viral URTIs and contribute to antibiotic resistance and unnecessary adverse effects.1, 2

Diagnosis and Etiology

• Most URTIs (including common cold, acute rhinosinusitis, and acute pharyngitis) are caused by viruses and are self-limiting conditions that typically resolve without specific antimicrobial therapy 2, 3
• The average duration of viral URTIs ranges from 6.6 to 8.9 days, with some infections lasting up to 15 days, particularly in children in daycare settings 4
• Viral etiology should be suspected when symptoms include rhinorrhea, nasal congestion, cough, sore throat, and mild fever without focal chest signs 1, 3

Recommended Management Approach

Symptomatic Treatment

• For bothersome dry cough, dextromethorphan or codeine may be prescribed 1
• Over-the-counter medications can be used for symptom management in adults, though the FDA advises against their use in children younger than 6 years 2
• Expectorants, mucolytics, antihistamines, and bronchodilators should NOT be prescribed for acute URTIs in primary care (strong recommendation) 1

When to Avoid Antibiotics

• Antibiotics should NOT be used for the common cold, influenza, or viral laryngitis 3
• Treatment of URTIs with antibiotics will NOT prevent progression to lower respiratory tract infections 1
• Antibiotic treatment should be withheld unless there are specific indications of bacterial infection 1, 3

Early Intervention Strategies

• Early intervention before peak viral shedding can reduce symptom severity and viral transmission 5
• Mucoadhesive gel nasal sprays may help create a barrier against viral particles, though evidence for their effectiveness is still emerging 5

When to Suspect Bacterial Infection

Antibiotics should only be considered when bacterial infection is suspected based on:

• Symptoms lasting longer than 10 days 2
• Temperature greater than 39°C (102.2°F) 2
• Worsening symptoms after initial improvement (suggesting secondary bacterial infection) 2
• Presence of focal chest signs suggesting pneumonia 1
• For pharyngitis, antibiotics should only be prescribed if testing confirms group A streptococcal infection 2, 3

Special Considerations

For Immunocompromised Patients

• In hematopoietic stem cell transplant patients with respiratory syncytial virus (RSV) infection, treatment with ribavirin (aerosolized or systemic) may be considered 1
• Deferral of conditioning therapy should be considered for patients with viral respiratory infections planned for allogeneic hematopoietic stem cell transplantation 1

Infection Control Measures

• Limit movement of patients with diagnosed or suspected viral respiratory infections to essential purposes only 1
• Healthcare personnel with acute upper respiratory infections should be restricted from caring for high-risk patients (e.g., immunocompromised patients, premature infants) 1
• Persons with respiratory infection symptoms should not visit pediatric, immunosuppressed, or cardiac patients 1

Prevention Strategies

• Annual influenza vaccination is recommended for persons at increased risk of complications due to influenza (age ≥65 years, institutionalization, chronic cardiac or pulmonary diseases, diabetes mellitus, chronic renal diseases) 1
• Intensified oral care in nursing home residents should be considered as a preventive measure to reduce pneumonia incidence 1
• The use of anti-viral medications for influenza prevention is only recommended in unusual situations (e.g., outbreaks in closed communities) 1

Common Pitfalls to Avoid

• Prescribing antibiotics for viral infections, which contributes to antibiotic resistance without providing benefit 2, 3
• Failing to recognize when a viral URTI has progressed to a bacterial infection requiring antibiotic therapy 2
• Using mucolytics, expectorants, or bronchodilators which have not shown benefit in viral URTIs 1
• Neglecting infection control measures that can prevent transmission, especially to high-risk individuals 1