Correct—No Systemic Steroids for Rhinovirus
Based on the highest quality guideline evidence, systemic corticosteroids should NOT be used for rhinovirus infections or acute post-viral rhinosinusitis. The EPOS2020 guidelines explicitly advise against systemic corticosteroids due to lack of benefit on recovery and potential harm 1.
Why Systemic Steroids Are Not Recommended
The evidence is clear and consistent:
- Systemic corticosteroids do not improve recovery at 7-14 days in acute post-viral rhinosinusitis 1
- While there is a small effect on facial pain at days 4-7, this minimal benefit does not justify the potential adverse events 1
- The quality of evidence is low, and the numbers needed to treat are unfavorable 1
- Acute post-viral rhinosinusitis (including rhinovirus) is a self-limiting disease that resolves without steroids 1
What You Should Use Instead
First-line symptomatic treatment includes:
- Analgesics (acetaminophen or ibuprofen) for pain and fever relief 2, 3
- Nasal saline irrigation to relieve congestion and facilitate mucus clearance 2, 3
- Intranasal corticosteroids (NOT systemic) may provide modest symptom relief, though the effect is small 1
Special Circumstances to Consider
The only exception where steroids might be considered:
- In patients with underlying asthma experiencing rhinovirus-triggered exacerbations, inhaled corticosteroids may help with airway hyperresponsiveness 4
- However, even in asthma, inhaled steroids do not prevent rhinovirus-induced inflammatory changes in the airways 4
Common Pitfalls to Avoid
- Do not prescribe antibiotics for rhinovirus—they are completely ineffective for viral illness and contribute to antimicrobial resistance 1, 2
- Do not use systemic steroids based on symptom severity alone—the evidence shows no meaningful benefit 1
- Avoid topical nasal decongestants beyond 3-5 days to prevent rebound congestion 2, 3
When to Reassess
Instruct the patient to return if: