Treatment of Rhinovirus Infection
Rhinovirus infection requires only symptomatic treatment—there is no effective antiviral therapy, and antibiotics should never be prescribed as they are completely ineffective for this viral illness. 1, 2
Understanding Rhinovirus Infection
Rhinovirus is the most common cause of the common cold, accounting for up to 98% of acute viral upper respiratory infections. 3 The illness is self-limited, typically lasting 6.6 to 8.9 days, though symptoms may persist up to 15 days in 7-13% of cases without indicating bacterial infection. 3 Importantly, symptoms are caused by the host inflammatory response rather than direct viral damage to the nasal epithelium. 4
First-Line Symptomatic Treatment
The primary treatment approach consists of three evidence-based interventions:
Analgesics/antipyretics (acetaminophen or NSAIDs like ibuprofen) for pain relief and fever control are recommended as first-line therapy. 1, 5 Pain relief is a major treatment goal since discomfort is the primary reason patients seek care. 1
Nasal saline irrigation helps relieve congestion and facilitates clearance of nasal secretions. 1, 5 This simple measure provides significant relief and is often underutilized. 1
Adequate hydration can help thin secretions and support recovery. 1
Additional Symptomatic Options
Oral decongestants (such as pseudoephedrine) may provide symptomatic relief, though they should be used cautiously in patients with hypertension or anxiety. 1
First-generation antihistamine/decongestant combinations containing sustained-release pseudoephedrine and brompheniramine have shown efficacy in reducing cough and other symptoms. 1 However, newer non-sedating antihistamines are relatively ineffective for common cold symptoms. 1
Topical nasal decongestants can be used for short-term relief but must be limited to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa). 1
Topical intranasal corticosteroids may provide modest symptom relief. 1
What NOT to Do
Antibiotics are completely contraindicated for rhinovirus infection. 1, 2 They are ineffective for viral illness, expose patients to unnecessary adverse effects, contribute to antimicrobial resistance, and add unnecessary costs. 1 This is true even when nasal discharge becomes colored or purulent, as color reflects neutrophil presence from inflammation, not bacterial infection. 3, 6
When to Consider Bacterial Superinfection
Only consider antibiotics if the patient develops acute bacterial rhinosinusitis, defined by:
- Persistent symptoms for ≥10 days without improvement, OR 1, 6
- Severe symptoms including fever >39°C, purulent nasal discharge, and facial pain for ≥3 consecutive days, OR 1, 6
- "Double sickening" pattern—initial improvement followed by worsening within 10 days 1, 6
The typical progression shows fever and myalgia resolving by day 5, while nasal congestion and cough may persist into weeks 2-3 without indicating bacterial infection. 3
Special Population Considerations
Children under 3 years: Avoid decongestants and antihistamines due to potential adverse effects. 1
Pregnant women: Use acetaminophen as first-line for pain and fever. 5
Patients with asthma or COPD: Monitor closely as rhinovirus can trigger exacerbations. 2, 7
Common Clinical Pitfalls
Prescribing antibiotics based on colored nasal discharge alone is inappropriate—this does not distinguish viral from bacterial infection. 3, 6
Assuming symptoms lasting >7 days indicate bacterial infection—viral rhinovirus infections commonly last 10-15 days. 3
Prolonged use of topical decongestants beyond 3-5 days leads to rebound congestion. 1
Underutilizing simple measures like saline irrigation and adequate hydration deprives patients of significant relief. 1