What are the recommended treatments for a rhinovirus infection in an otherwise healthy adult, including symptom management and care for underlying asthma or COPD?

Treatment Recommendations for Rhinovirus Infection

Rhinovirus infections should be managed with symptomatic treatment only—antibiotics are completely ineffective and should never be prescribed. 1, 2

Core Symptomatic Management

First-Line Therapies

• Analgesics/antipyretics (acetaminophen 1000mg every 4-6 hours, maximum 4g/24h, or ibuprofen) are the cornerstone of treatment for pain, headache, and fever relief. 1, 2, 3
• Nasal saline irrigation (2-3 times daily) provides low-risk relief of congestion and facilitates clearance of nasal secretions—this simple measure is often underutilized despite significant benefit. 1, 2, 3
• Topical intranasal corticosteroids may provide modest symptom relief, though the effect is small and takes approximately 15 days to manifest. 1, 4

Second-Line Symptomatic Options

• Oral decongestants (e.g., pseudoephedrine) can provide symptomatic relief but should be avoided in patients with hypertension, anxiety, cardiac arrhythmia, angina, cerebrovascular disease, bladder neck obstruction, or glaucoma. 1, 2
• Topical nasal decongestants (e.g., oxymetazoline) may be used for severe congestion but must be limited to 3-5 days maximum to prevent rebound congestion (rhinitis medicamentosa). 1, 2, 3
• First-generation antihistamine/decongestant combinations (containing pseudoephedrine and brompheniramine) may reduce symptoms through a drying effect, with 1 in 4 patients experiencing significant relief. 2, 3

Zinc Supplementation

• Zinc lozenges (≥75mg/day as zinc acetate or zinc gluconate) started within 24 hours of symptom onset significantly reduce the duration of the common cold and should be continued throughout the illness. 1, 3
• Patients should be counseled about potential adverse effects including nausea and bad taste. 3

What NOT to Do

Antibiotics Are Contraindicated

• Never prescribe antibiotics for rhinovirus infection—they provide no benefit, do not prevent complications (bacterial sinusitis, otitis media, asthma exacerbations), and cause adverse effects in 40-43% of patients. 1, 2, 3
• Purulent (colored) nasal discharge reflects neutrophil activity, not bacterial infection, and should not trigger antibiotic therapy. 1, 3

Other Ineffective Therapies

• Systemic corticosteroids do not improve recovery and should be avoided due to potential harm without meaningful benefit. 1, 4
• Newer-generation non-sedating antihistamines are ineffective for common cold symptoms and should not be used. 2
• Echinacea and vitamin C have no proven benefit for treatment of established infection. 1, 3

Special Populations

Children Under 3 Years

• Avoid decongestants and antihistamines due to possible adverse effects. 3
• Focus on saline irrigation and analgesics only. 4

Patients with Asthma or COPD

• Monitor closely for symptom progression as rhinovirus is a major trigger for exacerbations in these populations. 5, 6, 7
• Consider earlier intervention if respiratory status deteriorates. 4
• Continue baseline asthma/COPD medications and optimize control. 6

Patient Education and Follow-Up

Expected Course

• Symptoms typically peak within 3 days and resolve within 10-14 days without treatment. 1, 3
• Symptoms may persist up to 15 days in 7-13% of cases without indicating bacterial infection. 3
• Progression from clear to thick yellow-green discharge over 2-3 days is normal for viral infection. 3

When to Reassess

Instruct patients to return if: 3, 4

• Symptoms persist ≥10 days without improvement
• High fever (≥39°C) with purulent discharge and facial pain for ≥3-4 consecutive days
• "Double-worsening" (initial improvement followed by worsening within 10 days)
• Severe headache, visual changes, periorbital swelling, altered mental status, or cranial nerve deficits (red flags for complications)

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on symptom duration alone—rhinovirus infections commonly last 10-15 days. 3
• Do not use colored nasal discharge as an indication for antibiotics—this is a normal feature of viral inflammation. 1, 3
• Do not underutilize simple measures like saline irrigation and adequate hydration, which provide significant relief. 1, 3
• Do not extend topical decongestant use beyond 5 days—this leads to rebound congestion requiring prolonged treatment. 1, 2