What is the recommended treatment for an adult with a viral upper respiratory tract infection presenting with cough, sore throat, nasal congestion, and low‑grade fever?

Treatment for Viral Upper Respiratory Tract Infection

Antibiotics are not recommended for viral URIs; treatment consists of symptomatic management only. 1, 2, 3

Core Management Principle

The vast majority (>80-90%) of acute URIs are viral in origin and resolve spontaneously within 1-2 weeks without antibiotics. 1 Antibiotic treatment does not enhance illness resolution and contributes to adverse events, antibiotic resistance, and unnecessary costs. 2, 3

Symptomatic Treatment Approach

Recommended symptomatic therapies include:

• Analgesics/antipyretics: Acetaminophen, ibuprofen, or naproxen for pain, sore throat, headache, and fever 4
• Decongestants and/or antihistamines for nasal congestion and rhinorrhea 4
• Reassurance about expected symptom duration (typically 1-2 weeks) and self-limited nature of the illness 1

Critical Decision Point: When to Consider Antibiotics

Do NOT prescribe antibiotics unless the patient meets criteria for bacterial superinfection. 5, 1 The following three presentations suggest bacterial rhinosinusitis rather than uncomplicated viral URI:

1. Persistent symptoms ≥10 days without any clinical improvement 5, 1
2. Severe onset: High fever (≥39°C) AND purulent nasal discharge or facial pain for at least 3-4 consecutive days at illness onset 5
3. "Double-sickening": Worsening symptoms (new fever, headache, or increased nasal discharge) after initial improvement at days 5-6 5, 1

Common Pitfalls to Avoid

Purulent nasal discharge or sputum color does NOT indicate bacterial infection and does not justify antibiotic use. 1, 2 Patients with these symptoms do not benefit from antibiotics. 1

Do not prescribe antibiotics based on symptom duration alone within the first 10 days, as this represents the normal viral course. 1

Up to 90% of viral URIs show CT evidence of sinus involvement, yet these resolve without antibiotics. 1 Radiographic findings alone do not warrant treatment.

Follow-Up Guidance

Advise patients to return only if:

• Symptoms persist beyond 10 days without improvement 1
• Symptoms worsen after initial improvement 5
• High fever (≥39°C) develops with severe facial pain 5
• Symptoms exceed the expected 2-week recovery period 1