What is the recommended treatment for viral upper respiratory infections (URI) in children during the fall and winter?

Management of Viral Upper Respiratory Infections in Children During Fall/Winter

For most children with viral upper respiratory infections (URIs) during fall and winter, supportive care with antipyretics and adequate hydration is the recommended treatment, avoiding unnecessary antibiotics unless there are specific indications of bacterial infection. 1

Initial Assessment and Management Based on Severity

Mild Symptoms (Treat at Home)

• Children with coughs and mild fevers should be managed at home with antipyretics and adequate fluids 1
• Aspirin should NOT be used in children under 16 years of age due to risk of Reye syndrome 1
• Over-the-counter medications for symptom relief should be used cautiously, particularly in children under 6 years 2

Moderate Symptoms (Community Management)

• Children with high fever (>38.5°C) and cough or influenza-like symptoms should be evaluated by a healthcare professional 1
• If no features suggesting high risk of complications, treatment should focus on symptomatic relief 1
• Children under one year of age and those with risk factors for complications should be evaluated by a physician 1

High-Risk Features Requiring Medical Evaluation

• Breathing difficulties or respiratory distress 1
• Severe earache 1
• Vomiting lasting >24 hours 1
• Drowsiness 1
• Chronic co-morbid conditions (cardiac, respiratory, neurological disease) 1
• Temperature >38.5°C with concerning symptoms 1

Supportive Care Recommendations

Hydration

• Maintain adequate oral fluid intake; this is crucial for recovery 1
• For children unable to maintain oral intake due to breathlessness or fatigue, enteral routes should be considered 1
• In severe cases requiring hospitalization, intravenous fluids may be given at 80% basal levels to avoid complications of inappropriate ADH secretion 1

Fever Management

• Antipyretics (acetaminophen or ibuprofen) can be used for fever and pain relief 3
• Dosing should be appropriate for age and weight 1

Oxygen Therapy (If Hospitalized)

• Patients with oxygen saturation ≤92% while breathing room air should receive supplemental oxygen 1
• Oxygen should be administered via nasal cannulae, head box, or face mask to maintain saturation above 92% 1

Specific Considerations for Common Viral URIs

Common Cold

• Primarily supportive care with rest, hydration, and antipyretics 2
• Antibiotics should NOT be prescribed as they are ineffective against viral infections 3
• Symptoms typically resolve within 7-10 days 2

Viral Pharyngitis

• Symptomatic treatment with antipyretics and adequate hydration 1
• Antibiotics should only be prescribed if testing confirms Group A Streptococcal infection 1

Viral Rhinosinusitis

• Bacterial etiology is more likely if symptoms last >10 days, temperature >39°C, or symptoms worsen after initial improvement 2
• Antibiotics are not recommended unless symptoms worsen or don't improve after an additional 7 days 2

When to Consider Antiviral Therapy

For Influenza

• Oseltamivir is the antiviral of choice for children with confirmed or suspected influenza 1
• Consider treatment if:
  • Child has acute influenza-like illness with fever (>38.5°C) 1
  • Symptoms have been present for two days or less 1
  • For severely ill hospitalized children, oseltamivir may be used if symptomatic for <6 days 1
• Dosing is age and weight-dependent:
  • Children ≥24 months: 4 mg/kg/day in 2 doses for 5 days 1
  • Children 9-23 months: 7 mg/kg/day in 2 doses 1
  • Children 0-8 months: 6 mg/kg/day in 2 doses 1

When to Consider Antibiotics

• Antibiotics should NOT be routinely prescribed for viral URIs 1, 2
• Consider antibiotics only when bacterial infection is strongly suspected or confirmed 1
• For children at risk of complications or with severe disease requiring hospitalization, antibiotics providing coverage against S. pneumoniae, S. aureus, and H. influenzae may be considered 1
• For children under 12 years, co-amoxiclav is the drug of choice if antibiotics are necessary 1
• For children allergic to penicillin, clarithromycin or cefuroxime are alternatives 1

Prevention Strategies

• Frequent handwashing and contact isolation can prevent spread of viral infections 4
• Children should be kept home from school or daycare during acute illness 5
• Avoid exposing high-risk children to individuals with respiratory infections 1
• For RSV prevention in high-risk infants <24 months, consider monthly palivizumab during peak season 1, 4

Criteria for Hospital Discharge

Children can be safely discharged from hospital when they 1:

• Are clearly improving
• Are physiologically stable
• Can tolerate oral feeds
• Have a respiratory rate <40/min (<50/min in infants)
• Have an awake oxygen saturation of >92% in room air

Follow-up Recommendations

• Children on adequate therapy should show clinical improvement within 48-72 hours 1
• For children whose condition deteriorates or shows no improvement within 48-72 hours, further investigation should be performed 1
• Routine follow-up chest x-rays are not necessary for uncomplicated cases 1