Management of Upper Respiratory Infections

Diagnosis and Assessment

Most Upper Respiratory Infections (URIs) are viral in nature, with fewer than 2% of viral URIs complicated by acute bacterial rhinosinusitis (ABRS), according to the American College of Physicians 1
The American Academy of Pediatrics suggests that discolored nasal discharge alone does not indicate bacterial infection; it is a sign of inflammation and not specific for infection 5

The American College of Physicians recommends analgesics/antipyretics such as acetaminophen or ibuprofen for pain, fever, and inflammation 1
Adequate hydration and rest are supportive measures, as suggested by the American Academy of Family Physicians 2

The Infectious Diseases Society of America recommends considering antibiotics for patients with persistent symptoms for more than 10 days without clinical improvement, severe symptoms including high fever and purulent nasal discharge, or worsening course 4
The American Academy of Pediatrics suggests that antibiotics should be reserved for patients with specific clinical presentations suggesting bacterial infection, such as high fever and purulent nasal discharge 5

The American College of Physicians recommends amoxicillin as the preferred first-line agent for patients meeting criteria for acute bacterial rhinosinusitis 1
The Infectious Diseases Society of America suggests that amoxicillin-clavulanate is recommended for patients who have taken amoxicillin in the previous 30 days, those with concurrent conjunctivitis, or when coverage for β-lactamase–positive organisms is desired 4

The American College of Physicians states that radiographic imaging has no role in distinguishing bacterial from viral sinusitis and should not be performed routinely 1
The American Academy of Pediatrics notes that unnecessary antibiotic use contributes to antibiotic resistance and can cause more harm than benefit (number needed to harm = 8, number needed to treat = 18) 5

The American Academy of Pediatrics recommends that children may require different management approaches, with specific criteria for diagnosis and treatment 5