Management of Viral Upper Respiratory Tract Infection
For a patient with runny nose, phlegm, and low-grade fever, provide symptomatic treatment only—antibiotics are not indicated and cause more harm than benefit. 1, 2
Immediate Symptomatic Management
Start with first-generation antihistamine/decongestant combinations for rhinorrhea and post-nasal drip as first-line therapy. 1 These medications directly address the runny nose and phlegm production you're experiencing.
- Use intranasal corticosteroids as the most effective medication class for controlling nasal symptoms and reducing inflammation. 1
- Take acetaminophen or NSAIDs (ibuprofen, naproxen) for fever and any body aches. 1, 3, 4
- Perform saline nasal irrigation for additional symptomatic relief. 1
- Consider zinc supplementation, which has proven effectiveness for cold symptoms in adults. 4
Critical Pitfall to Avoid
Do not use phenylephrine or other decongestants for more than 3-7 days, as this causes rebound congestion (rhinitis medicamentosa). 1 If you've been using decongestants, stop them immediately and switch to the treatments listed above.
When Antibiotics Are NOT Needed
Your current symptoms represent a viral infection that will resolve on its own within 7-10 days. 5, 6 The vast majority of upper respiratory infections with runny nose, phlegm, and low-grade fever are viral and do not require antibiotics. 7, 8
- Antibiotics provide no benefit for viral infections and have a number needed to harm of only 8 compared to number needed to treat of 18. 1, 2
- Purulent (colored) nasal discharge is NOT an indication for antibiotics—this simply reflects inflammation, not bacterial infection. 1
When to Consider Bacterial Infection
Bacterial sinusitis should only be considered if you meet one of these three specific criteria: 9
- Persistent symptoms lasting ≥10 days without ANY improvement 9, 1
- Severe onset with high fever ≥39°C (102°F) AND purulent nasal discharge or facial pain for at least 3-4 consecutive days 9
- "Double-sickening"—worsening symptoms after initial improvement, with new fever, headache, or increased nasal discharge after 5-6 days 9, 5
If you meet bacterial criteria, first-line antibiotic treatment is amoxicillin for 10-14 days. 1
Expected Timeline and Follow-Up
Symptoms typically last 6-9 days but can persist up to 2 weeks in 7-13% of cases—this is normal for viral infections. 5 Nasal discharge and cough are the most persistent symptoms. 5
- Reassess in 3-5 days if symptoms persist or worsen. 1
- Isolate at home for 7 days from symptom onset to prevent transmission. 5
- Practice frequent handwashing, which is the most effective prevention method. 5
Return Immediately If You Develop:
- High fever (>39°C/102°F) 1
- Severe headache or facial swelling 1
- Visual changes or altered mental status 1
- Symptoms that worsen significantly after initial improvement 5
Why This Approach Matters
Avoiding unnecessary antibiotics prevents antimicrobial resistance and reduces adverse drug effects that occur in 1 out of every 8 patients treated. 2 Most upper respiratory infections are self-limiting and resolve with supportive care alone. 5, 7