What are the best treatments for an upper respiratory tract infection with symptoms of sore throat, congestion, and diminished taste and smell without fever?

Treatment for Upper Respiratory Tract Infection with Sore Throat and Congestion

This is a viral upper respiratory infection that does not require antibiotics—focus on symptomatic relief with analgesics, decongestants, and supportive care. 1

Why Antibiotics Are Not Indicated

Your relative's presentation is classic for a viral URI that does not warrant antibiotic therapy:

• No fever present - This is a key distinguishing feature. Bacterial infections typically cause fever >39°C (102.2°F) 1
• Symptom timeline is only 2 days - Bacterial complications are considered only when symptoms persist beyond 10 days without improvement, or when there's "double sickening" (worsening after initial improvement) 1
• Diminished taste and smell with congestion - These are characteristic viral symptoms, not bacterial 2
• No severe symptoms - No purulent nasal discharge lasting >3 consecutive days, no facial pain, no high fever 1

The evidence is clear: antibiotics provide more harm than benefit in viral URIs, with a number needed to harm of 8 versus number needed to treat of 18 for even bacterial sinusitis 1. Most URIs are viral and resolve spontaneously within 7 days 1, 3.

Recommended Symptomatic Treatment

For Sore Throat Pain

• Analgesics are the mainstay: Use aspirin, acetaminophen (Tylenol), or NSAIDs (ibuprofen, naproxen) 1, 3
• Throat lozenges can provide additional relief 1
• Salt water gargles or viscous lidocaine may help, though evidence is limited 1

For Congestion

• Oral decongestants such as pseudoephedrine temporarily relieve nasal and sinus congestion 4, 1
• Intranasal saline irrigation has good evidence for symptom relief 1
• Intranasal corticosteroids may alleviate symptoms 1
• Antihistamines can be tailored to specific symptoms like runny nose 1, 3

Red Flags Requiring Medical Reevaluation

Your relative should seek medical attention if any of these develop:

• Fever >38°C (100.4°F) persisting for more than 3 days - This suggests possible bacterial superinfection 5, 2
• Symptoms lasting beyond 10 days without improvement - This is the threshold for considering bacterial rhinosinusitis 1
• Worsening symptoms after initial improvement ("double sickening") - Suggests bacterial complication 1
• Severe symptoms developing: High fever >39°C with purulent nasal discharge or facial pain for ≥3 consecutive days 1
• Increasing shortness of breath or respiratory distress - May indicate pneumonia 5, 2
• Symptoms persisting beyond 3 weeks - Consider alternative diagnoses like asthma or postinfectious cough 5

Expected Clinical Course

• Typical duration: Most viral URIs resolve within 7 days 1, 3
• Symptom improvement: Should see gradual improvement over 3-4 days 1
• Reassessment timing: If symptoms persist or worsen, clinical follow-up within 2-3 days is appropriate 5, 2

Important Caveats

Do not test for strep throat unless there are specific findings like persistent fever, anterior cervical lymphadenopathy, and tonsillopharyngeal exudates—none of which are present here 1. The presence of congestion and rhinorrhea actually suggests viral rather than bacterial (streptococcal) etiology 5, 2.

Avoid unnecessary imaging - Chest X-rays or sinus imaging are not indicated in otherwise healthy adults with typical URI symptoms and normal vital signs 5.