What is the recommended treatment for nasopharyngitis?

Treatment of Nasopharyngitis

Nasopharyngitis (common cold) is a self-limiting viral illness that requires only symptomatic treatment; antibiotics are not indicated and should not be prescribed. 1

Diagnostic Considerations

• Nasopharyngitis is primarily viral, characterized by nasal congestion, rhinorrhea, sneezing, and/or nasal itching 1
• Symptoms typically peak within 3 days and resolve within 10-14 days without specific treatment 1
• Do not prescribe antibiotics for viral nasopharyngitis, as they are ineffective for viral illness, increase costs, expose patients to adverse effects, and contribute to antimicrobial resistance 1
• Patients with symptoms lasting less than 7 days have low probability of bacterial infection and do not require antibiotics 1

First-Line Symptomatic Treatment

Non-Pharmacological Measures

• Nasal saline irrigation relieves congestion and facilitates clearance of nasal secretions 1
• Adequate hydration helps thin secretions 1
• Environmental humidification alleviates mucosal dryness 1
• Adequate rest supports recovery 1

Pharmacological Symptomatic Treatment

• Acetaminophen or NSAIDs (ibuprofen) for pain and fever relief 1
• Topical intranasal corticosteroids may provide modest symptom relief 1
• Oral decongestants (pseudoephedrine) can provide symptomatic relief, but use cautiously in patients with hypertension or anxiety 1
• Topical nasal decongestants may be used for short periods only (maximum 3-5 days) to avoid rebound congestion (rhinitis medicamentosa) 1

Second-Line Options

• Antihistamines may provide relief of excessive secretions and sneezing, though evidence for efficacy in viral rhinitis is limited 1
• First-generation antihistamine/decongestant combinations containing sustained-release pseudoephedrine and brompheniramine have shown efficacy in reducing cough and other symptoms 1
• Newer non-sedating antihistamines are relatively ineffective for common cold symptoms 1

Special Populations

• In children under 3 years, avoid decongestants and antihistamines due to potential adverse effects 1
• In patients with chronic conditions like asthma, monitor symptom evolution closely 1

When to Consider Bacterial Infection

Only consider antibiotics if there is clear evidence of bacterial superinfection, such as: 1

• Symptoms persisting more than 7-10 days without improvement
• Worsening of symptoms after initial improvement (double worsening)
• Unilateral facial pain with purulent nasal discharge

These criteria suggest possible bacterial sinusitis rather than simple viral nasopharyngitis and warrant reassessment. 2

Patient Education: Red Flags Requiring Reevaluation

Educate patients to seek medical attention for: 1

• Persistent fever
• Severe pain
• Respiratory difficulty
• Symptoms worsening after initial improvement

Common Pitfalls to Avoid

• Do not prescribe antibiotics for uncomplicated viral nasopharyngitis - this is the most common error and contributes to antimicrobial resistance 1
• Do not use topical decongestants beyond 3-5 days to prevent rebound congestion 1
• Do not underutilize simple measures like saline irrigation and adequate hydration, which provide significant relief 1
• Do not assume bacterial infection based on purulent nasal discharge alone - this can occur with viral infections and does not justify antibiotic use 3