What is the recommended treatment for an otherwise healthy adult with a viral upper respiratory infection?

Treatment for Viral Upper Respiratory Infection

For an otherwise healthy adult with a viral upper respiratory infection, antibiotics should NOT be prescribed, as they provide no benefit and cause harm; treatment consists of symptomatic management with analgesics, antipyretics, decongestants, and supportive care. 1, 2, 3

Core Treatment Principles

What NOT to Do

• Do not prescribe antibiotics for viral URIs – they do not enhance illness resolution, provide no benefit, and increase antimicrobial resistance 1, 2, 3
• Purulent nasal discharge or sputum does NOT indicate bacterial infection and does NOT warrant antibiotics 1, 3
• Antibiotics should not be prescribed based on symptom duration alone within the first 10 days, as this represents normal viral course 1

Recommended Symptomatic Treatment

First-line symptomatic management includes: 2, 4

• Analgesics (acetaminophen or NSAIDs) for pain and headache relief 2, 5
• Antipyretics for fever management 2, 5
• Saline nasal irrigation to reduce nasal congestion 2
• Topical or systemic decongestants for nasal congestion 2, 5
• Intranasal corticosteroids for nasal inflammation 2
• Combination antihistamine-analgesic-decongestant products may provide symptom relief in approximately 1 in 4 patients 2

Expected Clinical Course

• Most uncomplicated viral URIs resolve spontaneously within 1-2 weeks 1, 4
• The majority of episodes resolve within the first week 1
• Patients should be advised to follow up only if symptoms worsen or exceed 2 weeks 1

When to Consider Bacterial Complications

Antibiotics should ONLY be considered if: 1, 2, 4

• Symptoms persist >10 days without improvement (suggests possible bacterial superinfection) 1, 4
• "Double sickening" pattern – worsening after initial improvement at day 5-7 1
• Severe symptoms – fever >39°C (102.2°F) with purulent discharge for ≥3 consecutive days 1, 4

If these criteria are met, consider chest X-ray to evaluate for pneumonia and reassess for bacterial rhinosinusitis 6, 4

Common Pitfalls to Avoid

• Do not use inhaled steroids, long-acting β2-agonists, oral mucolytics, or homeopathic substances – none are recommended for prevention or treatment of viral URIs 7
• Do not rely on N-acetylcysteine (NAC) – current guidelines do not include NAC as a recommended treatment for viral URIs 2
• Overreliance on unproven therapies while neglecting proven supportive measures is detrimental 2
• The vast majority (>80-90%) of acute URIs are viral, yet they remain the most common reason for inappropriate antibiotic prescriptions 1, 4

Patient Education

• Reassure patients that viral URIs are self-limited and typically resolve within 1-2 weeks 1, 8
• Explain that antibiotics will not help viral infections and may cause harm 2, 5, 3
• Advise patients to return if symptoms worsen, persist beyond 10 days without improvement, or if they develop high fever with severe symptoms 1, 4