Management of Viral Upper Respiratory Tract Infections (URTIs)

Diagnosis and Etiology

Viral etiology should be suspected when symptoms include rhinorrhea, nasal congestion, cough, sore throat, and mild fever without focal chest signs 2

For bothersome dry cough, dextromethorphan or codeine may be prescribed 2
Expectorants, mucolytics, antihistamines, and bronchodilators should NOT be prescribed for acute URTIs in primary care (strong recommendation) 2
Treatment of URTIs with antibiotics will NOT prevent progression to lower respiratory tract infections 3
Antibiotic treatment should be withheld unless there are specific indications of bacterial infection 2

In hematopoietic stem cell transplant patients with respiratory syncytial virus (RSV) infection, treatment with ribavirin (aerosolized or systemic) may be considered 5
Deferral of conditioning therapy should be considered for patients with viral respiratory infections planned for allogeneic hematopoietic stem cell transplantation 5

Limit movement of patients with diagnosed or suspected viral respiratory infections to essential purposes only 6, 7
Healthcare personnel with acute upper respiratory infections should be restricted from caring for high-risk patients (e.g., immunocompromised patients, premature infants) 6, 7
Persons with respiratory infection symptoms should not visit pediatric, immunosuppressed, or cardiac patients 6, 7

Annual influenza vaccination is recommended for persons at increased risk of complications due to influenza (age ≥65 years, institutionalization, chronic cardiac or pulmonary diseases, diabetes mellitus, chronic renal diseases) 8, 3
Intensified oral care in nursing home residents should be considered as a preventive measure to reduce pneumonia incidence 8
The use of anti-viral medications for influenza prevention is only recommended in unusual situations (e.g., outbreaks in closed communities) 3

Using mucolytics, expectorants, or bronchodilators which have not shown benefit in viral URTIs 2
Neglecting infection control measures that can prevent transmission, especially to high-risk individuals 6, 7