Outpatient / Infectious Disease
Upper Respiratory Tract Infection (URI)
# Upper Respiratory Tract Infection (URI)
Intake
-- Onset:***
-- Symptoms: *** (fever, cough, rhinorrhea, sneezing, sore throat, malaise, loss of smell)
-- Red Flags: *** (dyspnea, wheezing, fever >103, AMS, trouble swallowing, muffled voice)
-- Sick Contacts: ***
-- RFs: *** (co-morbidities, immunocompromised)
-- Vaccination Status: *** (COVID, influenza, Pneumo)
-- COVID Test: ***
DDx: viral URI, influenza, COVID, bacterial PNA, allergic rhinitis
Plan
-- Pain and Fevers: Tylenol 650mg q6 PRN or Ibuprofen 400 q6 PRN
-- Congestion: fluticasone, pseudoephedrine, guaifenesin
-- Cough: dextromethorphan
-- If dx with Influenza or risk contact - oseltamivir 75mg PO daily if within 48 hours
-- CXR if concern for underlying pneumonia
Template coming soon!
Patient Guidance and Information
URI Instructions
Based on your history and symptoms, you most likely have a viral infection causing an upper respiratory infection (also known as the common cold).
Symptoms of a common cold usually last 7-10 days, but a cough can last up to 3-4 weeks.
There is no role for antibiotics at this time since antibiotics do not treat viruses and can have side effects we try to avoid. The best thing you can do is stay hydrated and get plenty of rest.
Here are some general recommendations that may be helpful:
- You can take acetaminophen (Tylenol) 650mg every 6 hours as needed or Ibuprofen (Motrin) 400mg every 6 hours as needed for headaches and muscle pains.
- You can drink warm tea with honey or take over-the-counter medicines with dextromethorphan (Robitussin, DayQuil, Muxcinex, etc.) for cough as directed on the package
- Fluticasone (Flonase) nasal spray (1-2 sprays in each nostril daily) can be helpful with congestion
- Humidified air can help with congestion, sometimes people will run the shower hot and sit in the bathroom for 10-15 minutes
- Nasal irrigation kits can be bought at the pharmacy, only use distilled water, do not use tap water
Please call the office or present to the emergency department if you develop worsening shortness of breath, fevers greater than 103, or trouble swallowing or speaking.
If You Remember Nothing Else
Treatment is supportive unless there are red flags like dyspnea, fever >103, AMS or dysphagia.
Clinical Pearls
- When to Refer: shortness of breath, fevers >103, confusion, muffled voice
- Common cold refers to 200+ viruses - most common is rhinovirus - that is acute, self-limited, most commonly in fall and winter
- Other viruses include parainfluenza, coronavirus, adenovirus, and RSV
- RSV can be a nasty illness even in adults, and commonly causes bronchiolitis in infants
- Route of transmission is commonly through eyes and nose, not mouth
- Inflammation of nasal epithelium leads to increased blood flow and permeability which causes rhinorrhea, congestion, postnasal drip; the increased leukocyte concentration and enzymes are what lead to yellow-green color of nasal discharge
- In patients who have influenza or other bad URIs, be on the lookout for worsening symptoms after recovery - could portend a superimposed bacterial sinusitis, otitis media, PNA, etc.
- RVP not routinely recommended unless in inpatient setting and would change management in acutely ill patients
- Tamiflu (oseltamivir) is a neuraminidase inhibitor that inhibits the release of virus from host cells into the bloodstream
Trials and Literature
- Cochrane Meta-Analysis of Neuraminidase Inhibitors - shortens duration of symptoms by <1 day (14-17 days) but does not reduce hospitalization or complications of flu; NNT for SE of N/V was ~22-28
- Cochrane Meta-Analysis of Vaccines for Preventing Influenza in Healthy Individuals - NNT 71 to prevent flu, 29 in elderly, 5 in children; NNH 125 of fevers after vaccination
- Cochrane Meta-Analysis of Zinc for Common Cold - NNT 5 to reduce symptoms at 7 days, benefit only accrued for those taking within 24 hours of symptom onset; theory that zinc has anti-viral properties seen in in-vitro studies; issues with blinding since zinc tastes terribly
Other Resources
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