Upper Respiratory Infection (URI) in Adults and Adolescents

Background

• Upper respiratory infection (URI) describes acute inflammation of the upper respiratory tract that is usually viral in origin.
• It can cause a variety of symptoms such as nasal congestion, rhinorrhea, cough, sneezing, low grade fever, malaise, myalgia, headache, and/or a sore throat.
• URI is generally self-limiting and mild, but may last for > 10 days. The cough can last for 2-3 weeks.

Evaluation

• Upper respiratory infection (URI) is diagnosed clinically based on nasal congestion, rhinorrhea, cough, or sore throat in the absence of findings indicating streptococcal pharyngitis, acute bacterial sinusitis, lower respiratory tract infection, influenza, or allergic rhinitis.
• Testing is usually not needed, although may be considered (for example a chest X-ray) if symptoms fail to resolve in the expected timeframe.

Management

• Do not prescribe antibiotics for treatment of nonspecific URIs, as they are likely viral in origin (Strong recommendation).
• In the vast majority of patients, no specific treatment is required, although rest, hydration, and antipyretics are usually recommended. Receiving information and reassurance is strongly associated with patient satisfaction in patients with acute respiratory symptoms.
• Reinforce education about the importance of hand washing and oral and nasal hygiene (especially when sneezing, coughing, or blowing the nose), appropriate disposal of tissues, avoiding close contact with others, expected duration of symptoms, and when to report worsening symptoms.
• Consider any of the following for symptomatic relief:
  • acetaminophen (paracetamol) or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce fever or discomfort
  • decongestants (nasal or oral) for short-term relief of nasal congestion
  • a nonprescription short term antihistamine/decongestant (such as dexbrompheniramine/pseudoephedrine) which may reduce cough
  • ipratropium nasal spray to improve rhinorrhea
  • heated, humidified air does not show consistent benefit nor harms
  • most cough remedies, including guaifenesin, bromhexine, and codeine, have limited evidence of efficacy because of methodologic limitations, but there is some evidence that dextromethorphan is effective
• Herbal remedies that have limited evidence for benefit, but which may be considered in patient with upper respiratory tract infections, include:
  • Pelargonium sidoides extract (EPs 7360) to hasten the resolution of common cold symptoms
  • Andrographis paniculata to reduce common cold symptoms.