Respiratory Conditions: Upper Respiratory Tract Infections

Upper respiratory tract infections (URTIs) include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM). URTIs account for billions of dollars in annual health care costs; acute respiratory tract infections are the most common reason for acute care appointments. Although URTIs typically are viral, these infections are the most common reason for prescription of antibiotics in adults. Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years. Acute rhinosinusitis also typically is viral. A bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement. Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days. Acute pharyngitis also typically is of viral origin. Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive. AOM can be managed without antibiotics except in children younger than 6 months, children ages 6 to 23 months with bilateral AOM, children older than 2 years with bilateral AOM and otorrhea, and certain high-risk patients.