Upper respiratory tract infection

Small round red lesions may occur on the soft palate.[7] Decongestants may also cause decreased saliva.[7]

A URTI may be classified by the area inflamed. Rhinitis affects the nasal mucosa, while rhinosinusitis or sinusitis affects the nose and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses. Nasopharyngitis (rhinopharyngitis or the common cold) affects the nares, pharynx, hypopharynx, uvula, and tonsils generally. Without involving the nose, pharyngitis inflames the pharynx, hypopharynx, uvula, and tonsils. Similarly, epiglottitis (supraglottitis) inflames the superior portion of the larynx and supraglottic area; laryngitis is in the larynx; laryngotracheitis is in the larynx, trachea, and subglottic area; and tracheitis is in the trachea and subglottic area.

Prescribing antibiotics for laryngitis is not a suggested practice.[15] The antibiotics penicillin V and erythromycin are not effective for treating acute laryngitis.[15] Erythromycin may improve voice disturbances after a week and cough after 2 weeks, but any modest subjective benefit is not greater than the adverse effects, cost, and the risk of bacteria developing resistance to the antibiotics.[15] Health authorities have been strongly encouraging physicians to decrease the prescribing of antibiotics to treat common URTIs because antibiotic usage does not significantly reduce recovery time for these viral illnesses.[15] A 2017 systematic review found three interventions which were probably effective in reducing antibiotic use for acute respiratory infections: C-reactive protein testing, procalcitonin-guided management, and shared decision-making between physicians and patients.[16] The use of narrow-spectrum antibiotics has been shown to be just as effective as broad-spectrum alternatives for children with acute bacterial URTIs, and has a lower risk of side effects in children.[17] Decreased antibiotic usage could also have prevented drug-resistant bacteria. Some have advocated a delayed antibiotic approach to treating URTIs, which seeks to reduce the consumption of antibiotics while attempting to maintain patient satisfaction. A Cochrane review (updated 2017) of 11 studies and 3,555 participants explored antibiotics for respiratory tract infections. It compared delaying antibiotic treatment to either starting them immediately or to no antibiotics. Outcomes were mixed depending on the respiratory tract infection; symptoms of acute otitis media and sore throat were modestly improved with immediate antibiotics with minimal difference in complication rate. Antibiotic usage was reduced when antibiotics were only used for ongoing symptoms and maintained patient satisfaction at 86%.[18]

For sinusitis while at the same time discouraging overuse of antibiotics the CDC recommends:

• Target likely organisms with first-line medications: amoxicillin, amoxicillin/clavulanate
• Use the shortest effective course; should see improvement in 2–3 days. Continue treatment for 7 days after symptoms improve or resolve (usually a 10–14 day course).
• Consider imaging studies in recurrent or unclear cases; some sinus involvement is frequent early in the course of uncomplicated viral URI[4]

No good evidence exists for or against the effectiveness of over-the-counter cough medications for reducing coughing in adults or children.[19] Children under 2 years old should not be given any type of cough or cold medicine due to the potential for life-threatening side effects.[20] In addition, according to the American Academy of Pediatrics, the use of cough medicine to relieve cough symptoms should be avoided in children under 4 years old, and the safety is questioned for children under 6 years old.[21]

Disability-adjusted life year for URTIs per 100,000 inhabitants in 2002.[22]

  no data

  less than 10

  10–30

  30–60

  60–90

  90–120

  120–150

  150–180

  180–210

  210–240

  240–270

  270–300

  more than 300

According to a Cochrane review, a single oral dose of nasal decongestant in the common cold is modestly effective for the short-term relief of congestion in adults; however, data on the use of decongestants in children are insufficient. Therefore, decongestants are not recommended for use in children under 12 years of age with the common cold.[23] Oral decongestants are also contraindicated in patients with hypertension, coronary artery disease, and history of bleeding strokes.[24][25]

Mucolytics such as acetylcysteine and carbocystine are widely prescriped for upper and lower respiratory tract infection without chronic broncho-pulmonary disease. However, in 2013 a Cochrane review reported their efficacy to be limited.[26] Acetylcystine is considered to be safe for the children older than 2 years.[26]

Routine supplementation with vitamin C is not justified, as it does not appear to be effective in reducing the incidence of common colds in the general population.[27] The use of vitamin C in the inhibition and treatment of upper respiratory infections has been suggested since the initial isolation of vitamin C in the 1930s. Some evidence exists to indicate that it could be justified in persons exposed to brief periods of severe physical exercise and/or cold environments.[27] Given that vitamin C supplements are inexpensive and safe, people with common colds may consider trying vitamin C supplements to assess whether they are therapeutically beneficial in their case.[27]

Some low-quality evidence indicates the use of nasal irrigation with saline solution may alleviate symptoms in some people.[28] Also, saline nasal sprays can be of benefit.