Viral Upper Respiratory Tract Infection

Self-limiting viral infection of the upper respiratory tract, rhinovirus most common (>100 serotypes explains recurrent infections), also coronavirus, RSV, parainfluenza, adenovirus.

Transmitted via respiratory droplets/direct contact/fomites.

Gradual onset (distinguishes from abrupt influenza onset): rhinorrhea (initially clear, may become mucopurulent, does NOT indicate bacterial infection, normal viral course), nasal congestion, sneezing, sore throat, mild cough, low-grade fever (more common in children), malaise.

Duration typically 7-10 days, cough may persist longer (up to 3 weeks).

Clinical: no investigation needed for typical presentation.

Consider influenza/COVID testing if relevant seasonally/clinically (changes management, isolation).

Distinguish from bacterial complications requiring different management.

Differentials: influenza (more abrupt, systemic symptoms more prominent), allergic rhinitis (chronology, itch, no fever), COVID-19, acute bacterial sinusitis (if worsening after day 5-7 or persisting >10 days), streptococcal pharyngitis (if sore throat predominant with exudate/fever/no cough).

• Supportive care only: no antiviral/antibiotic indicated
• Analgesia/antipyretics: paracetamol, NSAIDs
• Adequate hydration, rest
• Saline nasal irrigation/sprays: symptomatic relief, safe for all ages
• Decongestants (pseudoephedrine, or topical oxymetazoline short-term ≤5-7 days): symptomatic relief, avoid in significant hypertension/cardiac disease (oral), caution rebound congestion (topical)
• Honey: reduces cough frequency/severity, first-line for children >1 year
• Zinc lozenges: modest evidence for reducing duration if started within 24h of onset
• Antibiotics NOT indicated: reinforce this, major driver of unnecessary prescribing and resistance
• Avoid aspirin in children (Reye's syndrome)

Complications warranting reassessment: symptoms worsening after initial improvement or persisting >10 days without improvement (bacterial sinusitis), high fever with focal chest signs (pneumonia), significant ear pain (otitis media), peritonsillar swelling/dysphagia (abscess).

Prevention: hand hygiene, avoid close contact when symptomatic, annual influenza vaccination (doesn't prevent common cold but reduces influenza burden).