UPPER RESPIRATORY TRACT INFECTION: TREATMENT GUIDELINES

Upper respiratory tract infections (URTIs) are among the most common infectious diseases worldwide and represent a significant cause of morbidity across all age groups. URTIs affect structures including the nasal cavities, sinuses, pharynx, and larynx. These infections are mainly viral in origin, though bacterial pathogens may contribute to complications or secondary infections. URTIs result in substantial healthcare utilization, absenteeism from work and school, and increased economic burden. Risk factors include environmental pollution, overcrowding, smoking, and poor nutritional status. Management primarily focuses on symptomatic treatment, preventive strategies, and rational antibiotic use to prevent resistance. This review summarizes the epidemiology, etiology, pathophysiology, clinical features, diagnosis, management, and preventive measures of URTIs.

• Heikkinen T, Järvinen A. The common cold. Lancet, 2003; 361(9351): 51-59.
• Eccles R. Understanding the symptoms of the common cold and influenza. Lancet Infect Dis., 2005; 5(11): 718-725.
• Monto AS. Epidemiology of viral respiratory infections. Am J Med., 2002; 112(Suppl 6A):         4S-12S.
• Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis., 2002; 2(1): 25-32.
• World Health Organization. Acute respiratory infections in children: case management in small hospitals in developing countries. Geneva: WHO, 2004.
• Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev., 2013; (6).
• Harris AM, Hicks LA, Qaseem A. Appropriate antibiotic use for acute respiratory tract infection in adults. Ann Intern Med., 2016; 164(6): 425-434.
• Kliegman RM, St Geme JW III, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier, 2023.
• Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis., 2018; 18(11): 1191–1210.
• World Health Organization. Household air pollution and health. Geneva: World Health Organization, 2023.
• United Nations Children's Fund. Pneumonia and other acute respiratory infections. New York: UNICEF, 2023.
• Berman S. Epidemiology of acute respiratory infections in children of developing countries. Rev Infect Dis., 1991; 13 Suppl 6: S454–62.
• Monto AS. Seasonal variation in respiratory virus infections. Am J Med., 2002; 112(6 Suppl): 4S–12S.
• World Health Organization. Ambient (outdoor) air pollution and health. Geneva: World Health Organization, 2024.
• Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution. Lancet, 2017; 389(10082): 1907–18.
• Mäkelä MJ, Puhakka T, Ruuskanen O, Leinonen M, Saikku P, Kimpimäki M, et al. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol, 1998; 36(2): 539-542.
• Mahony JB. Detection of respiratory viruses by molecular methods. Clin Microbiol Rev., 2008; 21(4): 716-747.
• Jacobs SE, Lamson DM, St George K, Walsh TJ. Human rhinoviruses. Clin Microbiol Rev., 2013; 26(1): 135-162.
• Bisno AL. Acute pharyngitis. N Engl J Med., 2001; 344(3): 205-211.
• Linder JA, Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989–1999. JAMA., 2001; 286(10): 1181-1186.
• Murphy TF. Respiratory infections caused by Moraxella catarrhalis: current status and future prospects. Clin Infect Dis., 1996; 23(6): 1249-1256.
• Pichichero ME. Evolving shifts in otitis media pathogens: relevance to a managed care organization. Am J Manag Care, 2005; 11(6 Suppl): S192-S202.
• Gwaltney JM Jr, Hendley JO. Rhinovirus infection of the upper respiratory tract. Am J Med., 1992; 92(6A): 25S-30S.
• Doyle WJ, Skoner DP, Fireman P, Seroky JT, Reilly BE. Cytokines and symptoms during common cold respiratory viral infection. J Infect Dis., 1992; 166(1): 194-199.
• Cohen S. Environmental factors and susceptibility to upper respiratory tract infections. Psychosom Med., 2005; 67(6): 930-934.
• Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med., 2004; 164(20):         2206-2216.
• Cohen S. Psychological stress and susceptibility to upper respiratory infections. Am J Respir Crit Care Med., 2005; 171(7): 680–685.
• Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med., 2004; 164(20):         2206–2216.
• Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB. Socioeconomic status and susceptibility to respiratory infections. JAMA., 2008; 299(4):  437–446.
• Eisner MD. Environmental tobacco smoke and respiratory health. Chest., 2002; 122(6): 2064–2070.
• Checkley W, Epstein LD, Gilman RH, Cabrera L, Black RE. Effects of acute and chronic malnutrition on respiratory infections. Am J Clin Nutr., 2008; 87(4): 1038–1045.
• Eduard W, Pearce N, Douwes J. Chronic respiratory health effects of occupational exposure to bioaerosols and dust. Occup Environ Med., 2009; 66(5): 309–313.
• Gwaltney JM Jr. Clinical aspects of rhinovirus infections. Am J Med., 2002; 112 Suppl 6A:           11S–18S.
• Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult upper respiratory tract infections. Eur Respir J., 2011; 38(2): 401–416.
• Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for acute respiratory infections. Clin Infect Dis., 2000; 31(2): 347–382.
• Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community. Am J Infect Control, 2008; 36(10): S274.e1–S274.e7.
• Jefferson T, Del Mar CB, Dooley L, et al. Physical interventions to interrupt respiratory virus transmission. Cochrane Database Syst Rev., 2011; CD006207.