What is the best over‑the‑counter treatment for an otherwise healthy adult or older child with influenza‑like illness or respiratory syncytial virus?

Over-the-Counter Treatment for Flu and RSV

There are no effective over-the-counter treatments for influenza or RSV—both conditions require prescription antivirals (for flu only) or supportive care, and OTC medications provide only symptomatic relief without altering disease course or reducing complications.

Why OTC Options Are Inadequate

For Influenza

• Oseltamivir (Tamiflu) is the only evidence-based treatment that shortens illness duration by 1–1.5 days and reduces complications like pneumonia (50% reduction) and otitis media (34% reduction in children) when started within 48 hours of symptom onset. 1
• Oseltamivir is prescription-only and not available over-the-counter in any formulation. 1
• No OTC medication—including acetaminophen, ibuprofen, decongestants, or cough suppressants—has been shown to reduce influenza illness duration, prevent complications, or lower hospitalization risk. 2

For RSV

• No antiviral treatment exists for RSV in otherwise healthy adults or children—management is entirely supportive. 3, 4, 5
• Ribavirin, the only RSV-specific antiviral, shows only marginal clinical benefit and is reserved for severely immunocompromised patients; it is not available OTC and not indicated for routine use. 4, 6
• Palivizumab is a monoclonal antibody used for prophylaxis only in high-risk infants (premature, congenital heart disease, chronic lung disease)—it is not a treatment and is administered by injection, not available OTC. 3, 4, 5

What OTC Medications Can and Cannot Do

Symptomatic Relief Only

• Acetaminophen or ibuprofen reduce fever and body aches but do not shorten illness, prevent complications, or reduce viral shedding. 1
• Decongestants and antihistamines may temporarily relieve nasal congestion but have no impact on disease severity or duration. 3, 4
• Cough suppressants and expectorants provide minimal symptomatic benefit and are not recommended in children under 6 years due to lack of efficacy and potential adverse effects. 3, 4

No Impact on Outcomes

• OTC medications do not reduce the risk of pneumonia, otitis media, hospitalization, or death from influenza or RSV. 1, 3, 4
• They do not shorten the duration of viral shedding or reduce transmission risk to household contacts. 1

When to Seek Prescription Treatment

Influenza

• All children under 2 years should receive immediate oseltamivir regardless of illness severity or vaccination status due to high complication risk. 1
• Adults ≥65 years, pregnant women, and patients with chronic medical conditions (cardiac, pulmonary, renal, hepatic, metabolic, neurologic, immunosuppression) should receive oseltamivir immediately. 2, 1
• Otherwise healthy adults and older children should receive oseltamivir if treatment can be started within 48 hours of symptom onset to reduce illness duration and complications. 1
• Treatment should not be delayed while awaiting laboratory confirmation—clinical suspicion during flu season is sufficient to initiate therapy. 1, 7

RSV

• No prescription antiviral exists for routine use—treatment is supportive with oxygen, hydration, and monitoring for respiratory distress. 3, 4, 5
• Hospitalization is indicated for infants with oxygen saturation ≤92%, severe respiratory distress, dehydration, or apnea. 2
• High-risk infants (premature, congenital heart disease, chronic lung disease) may receive palivizumab prophylaxis during RSV season, but this must be arranged before exposure—it is not a treatment. 3, 4, 5

Critical Pitfalls to Avoid

• Do not rely on OTC medications as primary treatment for influenza in high-risk patients—this delays effective antiviral therapy and increases complication risk. 1
• Do not wait for laboratory confirmation before starting oseltamivir in high-risk patients with influenza-like illness during flu season—rapid antigen tests have poor sensitivity and negative results should not exclude treatment. 1, 7
• Do not use aspirin in children or adolescents with influenza due to risk of Reye syndrome. 1
• Do not use bronchodilators, corticosteroids, or montelukast for RSV—trials have not demonstrated clinical benefit. 4, 5
• Do not use unproven remedies (elderberry syrup, zinc, vitamin C, echinacea) as substitutes for evidence-based treatment—no high-quality studies support their efficacy in influenza or RSV. 1

Supportive Care Measures (Adjunct to Prescription Treatment)

• Adequate hydration with oral fluids or IV fluids if unable to maintain intake. 2
• Oxygen therapy to maintain saturation >92% in children with respiratory distress. 2
• Fever management with acetaminophen or ibuprofen for comfort (not to prevent complications). 1
• Nasal saline irrigation and bulb suctioning in infants to relieve nasal congestion. 3, 4
• Isolation from high-risk contacts (infants <6 months, elderly, immunocompromised) to prevent transmission. 1