At-Home Symptomatic Treatment for Upper Respiratory Infections
Symptomatic therapy is the appropriate management strategy for upper respiratory infections, as antibiotics are not effective and lead to significantly increased risk for adverse effects. 1
First-Line Symptomatic Treatments
Analgesics and Antipyretics
- Acetaminophen (paracetamol) 500-1000 mg or aspirin 500-1000 mg are equally effective for fever and symptom relief, with both showing significant superiority over placebo for reducing fever, headache, achiness, and feverish discomfort. 2
- Ibuprofen or naproxen can also be used for pain or fever relief. 3
- These medications provide dose-related efficacy, with 1000 mg doses showing greater temperature reductions than 500 mg doses. 2
Nasal Symptoms
- Combination antihistamine-analgesic-decongestant products provide significant symptom relief in 1 out of 4 patients treated, though antihistamines alone have more adverse effects than benefits. 1
- Nasal decongestants with or without antihistamines are effective for nasal congestion in adults. 4
- Inhaled ipratropium bromide is effective for rhinorrhea and cough. 1, 4
- Nasal saline irrigation is safe and effective, particularly in children. 4
Cough Management
- Antitussives can provide relief for bothersome cough. 1
- Honey is effective for cough in children one year and older. 4
- Topical ointments containing camphor, menthol, and eucalyptus oils are effective in children. 4
Evidence-Based Supplements
Zinc
- Zinc supplements reduce the duration of common cold symptoms in healthy persons if administered less than 24 hours after symptom onset, though potential benefits must be weighed against adverse reactions such as nausea and bad taste. 1
Probiotics
- Lactobacillus casei may be beneficial in older adults, though evidence quality is lower. 4
Treatments NOT Recommended
- Vitamin C and echinacea have no evidence supporting their use for common cold treatment. 1
- Over-the-counter cold medications should not be used in children younger than 4-6 years. 1, 4
Patient Education and Safety Netting
Expected Duration and Follow-Up
- Patients should be advised that symptoms can last up to 2 weeks and should follow up if symptoms worsen rapidly or significantly, do not improve over the expected time, or they become systemically very unwell. 1
- Patients should return if fever persists beyond 48 hours or symptoms persist beyond 3 weeks. 5
- Cough may persist longer than other symptoms, which is normal and does not indicate treatment failure. 5
Prevention
- The most efficient means of transmission is direct hand contact; appropriate handwashing is the best method to reduce spread. 1
Red Flags Requiring Medical Evaluation
Immediate Assessment Needed
- Temperature <35°C or ≥40°C 5
- Respiratory rate ≥30 breaths/min 5
- Heart rate ≥125 beats/min 5
- Blood pressure <90/60 mmHg 5
- Cyanosis 5
- Confusion, drowsiness, or altered mental status 1, 5
- New or increased breathlessness 1
- Symptoms that worsen after initial improvement (suggesting bacterial superinfection) 1
When to Suspect Bacterial Complications
- Symptoms lasting longer than 10 days, temperature >39°C (102.2°F), or symptoms worsening after initial improvement suggest possible bacterial rhinosinusitis requiring medical evaluation. 6
- Complications such as acute bacterial sinusitis, asthma exacerbation, and otitis media may occur, though antibiotics do not prevent these complications. 1
Special Populations
Lower Threshold for Evaluation
- People with comorbidities or multimorbidity 1
- People who are frail 1
- Patients with chronic lung disease 7
Critical Pitfall to Avoid
Do not use antibiotics for uncomplicated upper respiratory infections, as they provide no benefit for viral illness and increase the risk of adverse effects and antibiotic resistance. 1 The common cold is a benign, self-limited viral illness, and antibiotics play no role in preventing complications. 1