What about managing other symptoms in patients with seasonal viral infections, such as cough, sore throat, and nasal congestion?

Managing Other Symptoms in Seasonal Viral Infections

For cough, sore throat, and nasal congestion in seasonal viral infections, use symptomatic treatment with analgesics (acetaminophen or NSAIDs), nasal saline irrigation, and short-term decongestants—antibiotics are never indicated for viral symptoms. 1, 2, 3

Cough Management

• For distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
• Encourage patients to avoid lying flat on their back, as this makes coughing ineffective 1, 2
• Honey can provide cough relief in patients over 1 year of age 2
• Dextromethorphan may provide benefit in adults, though evidence of clinical efficacy is limited 3, 4
• Codeine has NOT been shown to effectively treat cough caused by the common cold 4
• Cough may persist for up to 10 days or longer in viral infections without indicating bacterial infection 5, 3

Sore Throat Management

• Use acetaminophen or NSAIDs (ibuprofen) for pain relief and fever control 2, 3
• Throat lozenges and salt water gargles can provide symptomatic relief 2
• Continue analgesics only while symptoms of pain are present 2
• Sore throat may persist up to 12 days in 60% of patients with viral infections 5

Nasal Congestion and Rhinorrhea Management

First-Line Treatment

• Nasal saline irrigation is the cornerstone of treatment—it relieves congestion and facilitates clearance of nasal secretions 2, 3
• Topical intranasal corticosteroids may provide modest symptom relief 3

Decongestants

• Oral decongestants (pseudoephedrine) can provide symptomatic relief but use with caution in patients with hypertension or anxiety 3, 4
• Topical nasal decongestants should be limited to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa) 3, 4
• First-generation antihistamine/decongestant combinations (sustained-release pseudoephedrine with brompheniramine) have shown efficacy in reducing symptoms 3
• Newer non-sedating antihistamines are relatively ineffective for common cold symptoms 3, 4

Anticholinergics

• Topical ipratropium (prescription) relieves nasal symptoms in older children and adults 4

Hydration and Supportive Care

• Advise patients to drink fluids regularly to avoid dehydration, but no more than 2 liters per day 2
• Adequate hydration can help fluidify secretions 3
• Humidified air may be useful without adverse side effects 4

Critical Pitfalls to Avoid

Never Prescribe Antibiotics for Viral Symptoms

• Antibiotics are completely ineffective for viral infections and should never be prescribed for cough, sore throat, or nasal congestion alone 1, 3
• Antibiotics add to treatment costs, put patients at risk of adverse events, and contribute to antimicrobial resistance 3
• Colored nasal discharge alone is NOT a reliable indicator of bacterial infection 3
• Bacterial superinfection occurs in less than 2% of viral URI cases 5

When to Consider Bacterial Infection

• Only consider bacterial infection if symptoms persist beyond 10 days without improvement, or if "double worsening" occurs (initial improvement followed by deterioration within 10 days) 1, 5, 3
• Severe unilateral pain with high fever may indicate bacterial sinusitis 5
• Persistent fever (≥39°C) with purulent nasal discharge for at least 3 consecutive days suggests bacterial sinusitis 1

Medication-Specific Cautions

• Avoid prolonged topical decongestant use beyond 3-5 days 3, 4
• In children under 3 years, avoid decongestants and antihistamines due to possible adverse effects 3
• Guaifenesin and dextromethorphan are commonly used but lack evidence of clinical efficacy 3

Expected Clinical Course

• Most viral URI symptoms peak within 3 days and resolve within 7-10 days 5, 3
• Symptoms may last up to 15 days in 7-13% of cases without indicating bacterial infection 5, 3
• Nasal discharge and cough are the most persistent symptoms 5
• Reassure patients that viral symptoms typically last up to 2 weeks with supportive care alone 2

Return Precautions

Advise patients to seek immediate care if: 2

• Symptoms worsen after initial improvement
• High fever develops (>39°C)
• Difficulty breathing occurs
• Severe headache develops
• Inability to swallow