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Upper respiratory infection — Clinical Guidelines

Overview

Upper respiratory infections (URIs) encompass a range of illnesses affecting the nose, throat, pharynx, and larynx, commonly caused by viruses but sometimes involving bacterial complications. These infections are prevalent in pediatric populations and can influence procedural sedation outcomes and healthcare utilization 1 7 15.

Diagnosis

Clinical symptoms include rhinorrhea, sore throat, cough, and fever.

Diagnostic tests often include throat cultures or rapid antigen tests for streptococcal pharyngitis 19.

Imaging is rarely needed unless complications like sinusitis or otitis media are suspected 14.

Management

First-line treatments: Symptomatic relief with analgesics (e.g., acetaminophen, ibuprofen) and hydration 1 14.

Antibiotics: Reserved for confirmed bacterial infections such as streptococcal pharyngitis; dosing varies by pathogen 19.

Corticosteroids: Intramuscular corticosteroids may reduce healthcare utilization in adults with acute URIs 5.

Preventive measures: Emphasis on hygiene practices and avoiding unnecessary antibiotic use to prevent resistance 6 15.

Special Populations

Pediatrics: Higher risk of respiratory adverse events during procedural sedation with URI 1 7.

Elderly: Increased susceptibility to complications like sinusitis and otitis media; careful monitoring advised 3 14.

Comorbidities: Patients with underlying ENT conditions may require closer follow-up and tailored antibiotic stewardship 13.

Key Recommendations

Avoid unnecessary antibiotic use in URIs to prevent resistance (Evidence: Moderate 6 15).

Consider procedural sedation risks in children with URIs, implementing enhanced monitoring protocols (Evidence: Moderate 1 7).

Evaluate and treat confirmed bacterial infections with appropriate antibiotics, guided by culture results (Evidence: Strong 19).

Educate healthcare providers on judicious antibiotic prescription practices for URIs in children (Evidence: Moderate 15).

Monitor healthcare utilization in adults with URIs for potential benefits from corticosteroid interventions (Evidence: Moderate 5).

References

1 Tsze DS, Barrowman N, Bhatt M. Upper Respiratory Infections and Respiratory Adverse Events and Interventions in Emergency Department Sedation of Children. Annals of emergency medicine 2025. link 2 Ito S, Muraki Y, Inose R, Mizuno K, Goto R, Kiyosuke M et al.. Characteristics of pediatric patients claimed with acute upper respiratory infection during otorhinolaryngology consultations: A descriptive study of a large Japanese medical claims database. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2024. link 3 Abi Zeid Daou C, Yammine Y, Daou AM, Feghali PAR, Najjar W, Barazi R. Incidence of pediatric tonsillitis, otitis and upper respiratory infectious entities in the pre and post COVID-19 quarantine eras. Acta oto-laryngologica 2023. link 4 Kim SY, Yoo DM, Kim JH, Kwon MJ, Kim JH, Chung J et al.. Changes in Otorhinolaryngologic Disease Incidences before and during the COVID-19 Pandemic in Korea. International journal of environmental research and public health 2022. link 5 Parsel SM, Mohammed AE, Fort D, Barton BM, McCoul ED. Intramuscular Corticosteroids for Acute Upper Respiratory Infections Affects Healthcare Utilization. The Annals of otology, rhinology, and laryngology 2020. link 6 Frost HM, McLean HQ, Chow BDW. Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty. The Journal of pediatrics 2018. link 7 Mallory MD, Travers C, McCracken CE, Hertzog J, Cravero JP. Upper Respiratory Infections and Airway Adverse Events in Pediatric Procedural Sedation. Pediatrics 2017. link 8 Boel NM, Klokker M. Upper Respiratory Infections and Barotrauma Among Commercial Pilots. Aerospace medicine and human performance 2017. link 9 Ference EH, Min JY, Chandra RK, Schroeder JW, Ciolino JD, Yang A et al.. Antibiotic Prescribing by Physicians Versus Nurse Practitioners for Pediatric Upper Respiratory Infections. The Annals of otology, rhinology, and laryngology 2016. link 10 Swanljung E, Tapiovaara L, Lehtoranta L, Mäkivuokko H, Roivainen M, Korpela R et al.. Lactobacillus rhamnosus GG in adenoid tissue: Double-blind, placebo-controlled, randomized clinical trial. Acta oto-laryngologica 2015. link 11 Dubnov-Raz G, Rinat B, Hemilä H, Choleva L, Cohen AH, Constantini NW. Vitamin D supplementation and upper respiratory tract infections in adolescent swimmers: a randomized controlled trial. Pediatric exercise science 2015. link 12 Gurgel RK, Lund G, Gundlapalli AV. Role of otolaryngologists in health care for the homeless. The Annals of otology, rhinology, and laryngology 2009. link 13 Humayun F, Hoff PT, Robinson EA, Gunaratnam NT. Dosing of proton pump inhibitors is suboptimal among otolaryngologists treating reflux-induced upper-respiratory disease. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2007. link 14 Nokso-Koivisto J, Hovi T, Pitkäranta A. Viral upper respiratory tract infections in young children with emphasis on acute otitis media. International journal of pediatric otorhinolaryngology 2006. link 15 Razon Y, Ashkenazi S, Cohen A, Hering E, Amzel S, Babilsky H et al.. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. The Journal of antimicrobial chemotherapy 2005. link 16 Huntley AL, Thompson Coon J, Ernst E. The safety of herbal medicinal products derived from Echinacea species: a systematic review. Drug safety 2005. link 17 Metz JP. Upper respiratory tract infections: who plays, who sits?. Current sports medicine reports 2003. link 18 Ebenfelt A. Bacterial adherence to mucosal epithelium in the upper airways has less significance than believed. Journal of negative results in biomedicine 2003. link 19 Hover AR, Cornwell V, Stevenson S, Sponenberg D. Evaluation of the American Academy of Pediatrics Principles on Management of Common Office Infections in a managed care setting. Missouri medicine 2000. link 20 Epling CA. Upper respiratory problems. Primary care 2000. link70186-x)

Upper respiratory infection