Management of Viral Upper Respiratory Tract Infections (URTIs)
Viral URTIs should be managed with symptomatic treatment including analgesics/antipyretics, adequate hydration, and rest, while avoiding unnecessary antibiotics which are ineffective against viral illnesses and contribute to antibiotic resistance. 1, 2
Diagnosis
- Viral etiology should be suspected when symptoms include rhinorrhea, nasal congestion, cough, sore throat, and mild fever without focal chest signs 1
- Discolored nasal discharge alone does not indicate bacterial infection; it is a sign of inflammation and not specific for bacterial infection 2
First-Line Symptomatic Treatment
- Analgesics/antipyretics such as acetaminophen or ibuprofen for pain, fever, and inflammation 2, 3
- Adequate hydration and rest as supportive measures 2
- Nasal saline irrigation for minor improvements in nasal symptoms 2
Additional Symptomatic Relief Options
- Oral decongestants may provide symptomatic relief if no contraindications exist 2
- Topical decongestants can be used but should not exceed 3-5 days to avoid rebound congestion 2
- For bothersome dry cough, dextromethorphan or codeine may be prescribed 1, 2
- Expectorants such as guaifenesin may be used for symptomatic relief, though evidence of clinical efficacy is limited 2
Treatments to AVOID
- Expectorants, mucolytics, antihistamines, and bronchodilators should NOT be routinely prescribed for acute URTIs in primary care 1
- Antibiotics should be withheld unless there are specific indications of bacterial infection 1, 4
When to Suspect Bacterial Infection
- Symptoms lasting longer than 10 days 4
- Temperature greater than 39°C (102.2°F) 4
- Symptoms that worsen after initial improvement 4
- Presence of focal chest signs suggesting pneumonia 1
Special Populations
- 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 1
- Healthcare personnel with acute upper respiratory infections should be restricted from caring for high-risk patients 1
- Persons with respiratory infection symptoms should not visit pediatric, immunocompromised, or cardiac patients 1
- Hand hygiene and avoiding close contact with infected individuals can help prevent URTIs 2
Prevention Strategies
- Annual influenza vaccination is recommended for persons at increased risk of complications due to influenza 1
- Early intervention with mucoadhesive gel nasal sprays may help reduce symptom severity and viral transmission 5
- Nasal washing with saline solution may have prophylactic benefits 2
Follow-up Recommendations
- Patients should return if symptoms persist beyond 3 weeks, fever exceeds 4 days, dyspnea worsens, or patient stops drinking or consciousness decreases 2