Acute upper respiratory infectionMANAGEMENT

INFECTIOUS DISEASE PRESENTATIONS · 12 SECTIONS

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585 items

☷ Legend

01Approach to the Critical Patient/attcp47

Immediate threats

›Initial stabilization priorities

›Airway risk features

›Stridor

›Drooling

›Muffled voice

›Tripod positioning

›Inability to swallow secretions

›Breathing risk features

›SpO2 < 92% on room air or below baseline

›Severe tachypnea

›Accessory muscle use

›Cyanosis

›Circulation risk features

›Hypotension

›Altered mental status

›Poor perfusion

›Escalation triggers

›Activate resuscitation team for impending airway compromise

›If anaphylaxis concern, initiate anaphylaxis pathway

›If sepsis concern, initiate sepsis pathway

Triage and isolation

›Infection control

›Respiratory source precautions

›Masking for patient and staff per local policy

›Eye protection for aerosol generating procedures

›High contagion syndromes

›Influenza like illness during community circulation

›COVID like illness during community circulation

›Pertussis like cough syndrome

Key decision points

›Early decision nodes

›Predominantly viral URI syndrome

›Rhinorrhea

›Nasal congestion

›Sore throat

›Cough

›Low grade fever

›Alternate diagnosis flags

›Focal lung findings

›Pleuritic chest pain

›Persistent high fever

›Severe unilateral throat pain

›Neck swelling

›Trismus

›Severe headache with neurologic deficits

›Testing necessity decision

›Host risk factors for complications

›Need for targeted therapy

›Public health or isolation implications

02History/hx73

Presenting syndrome

›Symptom characterization

›Onset timing

›Duration in days

›Abrupt onset versus gradual onset

›Upper airway symptoms

›Nasal congestion

›Rhinorrhea

›Sneezing

›Sore throat

›Hoarseness

›Lower airway symptoms

›Cough

›Wheeze

›Dyspnea

›Chest pain

›Systemic symptoms

›Fever

›Myalgias

›Fatigue

›Headache

›GI symptoms

›Nausea

›Vomiting

›Diarrhea

Exposure and risk context

›Epidemiologic context

›Sick contacts

›Household exposure

›School or daycare exposure

›Recent travel

›Crowd exposure

›Known outbreaks

›Occupational exposure

›Healthcare setting

›Long term care setting

›Vaccination history

›Influenza vaccine current season

›COVID vaccine recent status

›Pertussis containing vaccine status

Red flags and complication screen

›High risk features

›Persistent or worsening course

›Symptoms > 10 days without improvement

›New fever after initial improvement

›Severe symptoms

›Severe sore throat with unilateral pain

›Difficulty swallowing

›Neck stiffness

›Facial swelling

›Respiratory compromise

›Dyspnea at rest

›Hemoptysis

›Dehydration

›Poor oral intake

›Oliguria

›Immunocompromise

›Transplant

›Active chemotherapy

›High dose steroids

›Advanced HIV

Past history and meds

›Baseline risk

›Asthma

›COPD

›Bronchiectasis

›Heart failure

›Diabetes

›CKD

›Pregnancy

›Medication history

›ACE inhibitor use

›Anticoagulants

›Immunosuppressants

›Allergy history

›NSAID hypersensitivity

›Decongestant intolerance

03Physical Exam/exam50

Vitals and general

›Physiologic severity

›Temperature

›Heart rate

›Blood pressure

›Respiratory rate

›SpO2 at rest

›General appearance

›Toxic appearance

›Work of breathing

›Hydration status

HEENT and neck

›Upper airway exam

›Nasal mucosa edema

›Nasal discharge character

›Oropharyngeal erythema

›Tonsillar exudates

›Uvular deviation

›Trismus

›Voice quality

›Ear exam

›TM erythema

›TM bulging

›Otorrhea

›Sinus exam

›Facial tenderness

›Periorbital edema

›Neck exam

›Cervical lymphadenopathy

›Neck stiffness

›Submandibular swelling

Chest and cardiopulmonary

›Lung findings

›Wheeze

›Crackles

›Decreased breath sounds

›Focal consolidation signs

›Cardiac exam

›Tachycardia disproportionate to fever

›Signs of heart failure

PITFALLS

›Missed serious illness patterns

›Epiglottitis pattern with minimal oropharyngeal findings

›Drooling

›Stridor

›Toxic appearance

›Peritonsillar abscess pattern

›Trismus

›Uvular deviation

›Hot potato voice

›Pneumonia pattern with normal upper airway exam

›Tachypnea

›Hypoxia

›Focal crackles

04Differential Diagnosis/ddx61

Common and benign

›Viral acute upper respiratory infection

›ICD-10 J06.9

›SNOMED CT Acute upper respiratory infection

›Acute nasopharyngitis common cold

›ICD-10 J00

›Acute pharyngitis viral

›ICD-10 J02.9

Targeted treatable infections

›Influenza

›ICD-10 J10.1

›Clues

›Abrupt onset

›Fever

›Myalgias

›COVID-19

›ICD-10 U07.1

›Clues

›Exposure history

›Systemic symptoms

›Group A streptococcal pharyngitis

›ICD-10 J02.0

›Clues

›Fever

›Tonsillar exudates

›Tender anterior cervical nodes

›Absence of cough

›Acute bacterial sinusitis

›ICD-10 J01.90

›Clues

›Persistent symptoms > 10 days

›Severe symptoms with fever and purulent discharge

›Worsening after initial improvement

›Pertussis

›ICD-10 A37.0

›Clues

›Paroxysmal cough

›Posttussive vomiting

›Prolonged cough > 2 weeks

Serious mimics and complications

›Community acquired pneumonia

›ICD-10 J18.9

›Clues

›Tachypnea

›Focal auscultation findings

›Hypoxia

›Epiglottitis

›ICD-10 J05.1

›Peritonsillar abscess

›ICD-10 J36

›Retropharyngeal abscess

›ICD-10 J39.0

›Ludwig angina

›ICD-10 K12.2

›Asthma exacerbation triggered by URI

›ICD-10 J45.901

›COPD exacerbation triggered by URI

›ICD-10 J44.1

›Pulmonary embolism

›ICD-10 I26.99

›Clues

›Pleuritic chest pain

›Unexplained tachycardia

›Disproportionate dyspnea

05Laboratory Tests/lt26

Minimal testing strategy

›Routine labs typically unnecessary in uncomplicated viral URI

›Exceptions

›Severe systemic illness

›Immunocompromise

›Suspected pneumonia or sepsis

Infectious testing

›Viral pathogen tests when results change management

›SARS-CoV-2 NAAT or rapid antigen per local performance and availability

›Higher utility with high pretest probability or high risk host

›Influenza A and B NAAT or rapid antigen in season

›Higher utility within 48 hours for antiviral decisions

›RSV testing in high risk adults or infants when it changes disposition

›Streptococcal pharyngitis tests when bacterial pharyngitis suspected

›Rapid antigen detection test

›If negative in children and adolescents, confirm with throat culture or NAAT per local practice

›Throat culture or NAAT

›Higher sensitivity than RADT

Inflammatory and organ function labs when complications suspected

›CBC with differential for severe illness

›Leukocytosis not specific for bacterial infection

›Neutrophil predominance supportive but non diagnostic

›CRP or procalcitonin selective use

›Limited role in routine URI

›Consider in equivocal pneumonia decisions per local pathways

›BMP for dehydration or high risk host

›Sodium and creatinine for volume status and renal function

›Venous blood gas when ventilatory failure risk

›Hypercapnia concern in COPD or severe asthma

06Diagnostic Tests/dt60

Scoring Systems

›Pharyngitis decision support

›Centor criteria adult

›Tonsillar exudates

›Tender anterior cervical lymphadenopathy

›Fever history

›Absence of cough

›McIsaac modification

›Age adjustment

›Improves applicability across age groups

›FeverPAIN optional tool in some settings

›Fever

›Purulence

›Attend rapidly within 3 days

›Inflamed tonsils

›No cough or coryza

›Pneumonia severity when pneumonia suspected

›CRB-65 or CURB-65

›Confusion

›Respiratory rate elevated

›Blood pressure low

›Age 65 or older

›Use for disposition support not as sole determinant

MRI

›MRI indications uncommon in routine URI

›Complicated sinusitis concern

›Orbital cellulitis

›Cavernous sinus thrombosis concern

›Intracranial extension concern

›Neck deep space infection with neurologic complication concern

›MRI limitations

›Access delays

›Motion sensitivity

›Sedation needs in pediatrics

›CT chest

›Pneumonia complication concern

›Empyema concern

›Abscess concern

›Alternative diagnosis concern

›PE pathway imaging per standard protocols

›CT neck with contrast

›Deep neck space infection concern

›Retropharyngeal abscess

›Parapharyngeal abscess

›Ludwig angina extent

›CT sinus

›Sinusitis complications concern

›Orbital involvement

›Neurologic symptoms

›CT appropriateness

›Avoid routine imaging in uncomplicated URI

Ultrasound

›Lung ultrasound

›Pneumonia support

›Focal B lines

›Subpleural consolidation

›Pleural effusion

›Peritonsillar abscess ultrasound

›Intraoral or transcutaneous when available

›Supports drainage decision and avoids blind needle aspiration

›Soft tissue ultrasound

›Cervical lymphadenitis abscess concern

›Cellulitis versus abscess differentiation

07Disposition/dispo25

Discharge versus admission

›Discharge criteria typical for uncomplicated URI

›Stable vitals

›SpO2 acceptable for age and baseline

›No respiratory distress

›Adequate oral intake or hydration plan

›No red flags for deep space infection or pneumonia

›Observation or admission indications

›Hypoxia

›Moderate to severe respiratory distress

›Inability to maintain hydration

›High risk host with worsening course

›Suspected complications

›Peritonsillar abscess requiring drainage and monitoring

›Deep neck infection

›Pneumonia requiring inpatient therapy

›Transfer criteria

›Airway compromise risk

›Need for ENT or anesthesia not available

›Pediatric ICU need

Follow-up planning

›Primary care follow-up

›Symptom persistence beyond expected course

›High risk comorbidities

›Specialty follow-up

›ENT for abscess, recurrent severe tonsillitis, airway concerns

›Pulmonology for recurrent wheeze or uncontrolled asthma

08Treatment/t136

Supportive care foundation

›Nonpharmacologic measures

›Hydration

›Oral fluids goal based on thirst and urine output

›Oral rehydration solution for vomiting or poor intake

›Rest and sleep

›Activity as tolerated

›Humidified air

›Nighttime symptom relief

›Saline nasal irrigation

›Isotonic sprays or rinses

›Honey for cough if age older than 1 year

›2.5 mL to 10 mL at bedtime based on age tolerance

Analgesic and antipyretic options

›Acetaminophen

›Adult dosing

›650 mg PO every 4 to 6 hours as needed

›Maximum 3000 mg per day typical outpatient limit

›Pediatric dosing

›15 mg per kg PO every 4 to 6 hours as needed

›Maximum 75 mg per kg per day

›Hepatic risk considerations

›Lower maximum in chronic liver disease or heavy alcohol use

›Ibuprofen

›Adult dosing

›400 mg PO every 6 to 8 hours as needed

›Maximum 1200 mg per day OTC typical

›Pediatric dosing

›10 mg per kg PO every 6 to 8 hours as needed

›Maximum 40 mg per kg per day

›NSAID precautions

›CKD

›GI bleed risk

›Dehydration

Nasal congestion and rhinorrhea

›Intranasal corticosteroids for prominent rhinitis symptoms

›Fluticasone

›Adult dosing

›1 to 2 sprays per nostril once daily

›Adolescent dosing

›1 spray per nostril once daily

›Intranasal ipratropium for rhinorrhea

›Ipratropium bromide nasal 0.03%

›Adult dosing

›2 sprays per nostril 2 to 3 times daily

›Adverse effects

›Nasal dryness

›Epistaxis

›Oral decongestants selective use

›Pseudoephedrine

›Adult dosing

›60 mg PO every 4 to 6 hours as needed

›Maximum 240 mg per day

›Avoid or caution

›Uncontrolled hypertension

›Significant arrhythmia history

›Severe anxiety or insomnia

›Phenylephrine oral

›Lower and inconsistent efficacy compared with pseudoephedrine in many settings

›Topical decongestants short course only

›Oxymetazoline nasal

›Adult dosing

›2 sprays per nostril every 12 hours as needed

›Maximum 3 days to reduce rebound congestion risk

Cough symptom control

›Dextromethorphan

›Adult dosing

›10 mg to 20 mg PO every 4 hours as needed

›Maximum 120 mg per day

›Drug interaction risk

›Serotonergic medications

›MAOI contraindication

›Guaifenesin

›Adult dosing

›600 mg to 1200 mg PO every 12 hours as needed

›Maximum 2400 mg per day

›Hydration supportive role

›Adequate fluid intake for expectoration

›Benzonatate adult only

›Adult dosing

›100 mg to 200 mg PO three times daily as needed

›Safety cautions

›Avoid in children due to severe toxicity risk

›Do not chew capsules

›Bronchodilator trial when wheeze present

›Salbutamol albuterol MDI

›Adult dosing

›2 puffs every 4 to 6 hours as needed

›Spacer use

›Improves delivery

›Nebulized albuterol for moderate distress

›Adult dosing

›2.5 mg nebulized every 20 minutes up to 3 doses then reassess

›Pediatric dosing

›0.15 mg per kg per dose nebulized every 20 minutes up to 3 doses then reassess

Antibiotic stewardship and targeted therapy

›Antibiotics not indicated for uncomplicated viral URI

›Stewardship rationale

›No benefit in viral syndromes

›Adverse effects and resistance risk

›Streptococcal pharyngitis treatment when confirmed or strongly suspected per local pathway

›Penicillin V

›Adult dosing

›500 mg PO twice daily for 10 days

›Amoxicillin

›Adult dosing

›500 mg PO twice daily for 10 days

›Pediatric dosing

›50 mg per kg per day PO once daily for 10 days

›Maximum 1000 mg per day

›Penicillin allergy non anaphylaxis

›Cephalexin

›Adult dosing

›500 mg PO twice daily for 10 days

›Pediatric dosing

›20 mg per kg per dose PO twice daily for 10 days

›Maximum 500 mg per dose

›Penicillin allergy anaphylaxis

›Azithromycin

›Adult dosing

›500 mg PO day 1 then 250 mg PO daily days 2 to 5

›Pediatric dosing

›12 mg per kg PO day 1 then 6 mg per kg PO daily days 2 to 5

›Acute bacterial sinusitis antibiotics when criteria met

›First line amoxicillin clavulanate adult

›875 mg and 125 mg PO twice daily for 5 to 7 days

›Pediatric dosing

›45 mg per kg per day amoxicillin component divided twice daily

›Alternative in beta lactam allergy

›Doxycycline adult

›100 mg PO twice daily for 5 to 7 days

›Avoid doxycycline in pregnancy and in young children per local guidance

Antiviral therapy when indicated

›Influenza antiviral therapy when likely or confirmed and within treatment window or high risk host

›Oseltamivir

›Adult dosing

›75 mg PO twice daily for 5 days

›Pediatric dosing

›Weight based dosing per local formulary

›COVID-19 outpatient antivirals for eligible high risk patients

›Eligibility requires local guideline alignment and drug interaction review

›Renal and hepatic function review before prescribing where required

09Special Populations/sp34

Pregnancy

›Pregnancy considerations

›Maternal risk

›Higher complication risk from influenza and COVID

›Lower threshold for testing and treatment when indicated

›Medication safety

›Acetaminophen preferred for fever and pain

›Avoid NSAIDs especially in later pregnancy

›Decongestants caution in hypertension or preeclampsia risk

›Escalation thresholds

›Any hypoxia

›Persistent high fever

›Reduced fetal movement concerns

Geriatric

›Older adult considerations

›Atypical presentation

›Blunted fever response

›Delirium as primary symptom

›Higher risk complications

›Pneumonia

›Dehydration

›Medication adverse effects

›Medication cautions

›Anticholinergics worsening urinary retention or confusion

›Decongestants worsening hypertension or arrhythmia

Pediatrics

›Pediatric considerations

›Airway size vulnerability

›Higher risk of respiratory distress with congestion

›Medication cautions

›Avoid OTC cough and cold products in young children per local guidance

›Avoid benzonatate in children

›Honey contraindicated under 1 year

›Dehydration risk

›Poor intake with fever and tachypnea

›Serious bacterial illness screen in infants

›Age under 3 months with fever requires separate pathway

10Background/b29

Epidemiology

›Epidemiology overview

›Viral pathogens predominate

›Rhinovirus common cause

›Seasonal coronaviruses common cause

›RSV and influenza seasonal contributions

›Transmission patterns

›Droplet and contact spread

›High household secondary transmission

Pathophysiology

›Pathophysiology overview

›Upper airway mucosal inflammation

›Nasal congestion from vascular engorgement

›Rhinorrhea from secretions

›Cough mechanisms

›Postnasal drip

›Airway hyperreactivity

›Fever and myalgias mechanisms

›Cytokine mediated systemic response

Therapeutic Considerations

›Treatment principles

›Symptom targeted therapy

›Analgesic and antipyretic

›Nasal symptom control

›Cough control selective

›Antibiotic stewardship

›Avoid antibiotics without bacterial syndrome evidence

›Use narrow spectrum when indicated

›Return precautions emphasis

›Worsening respiratory status

›Dehydration

›Complication signs

11Patient Discharge Instructions/pdi32

copy discharge instructions

›Discharge instruction set

›Expected course

›Symptoms often peak by day 2 to 3

›Cough may persist 2 to 3 weeks

›Home care

›Fluids and rest

›Saline nasal spray or rinse

›Humidified air

›Acetaminophen or ibuprofen as directed for fever or pain

›Infection prevention

›Hand hygiene

›Masking around high risk people while symptomatic

›Avoid sharing drinks or utensils

›Return to ED now

›Trouble breathing

›Blue lips or face

›SpO2 low if home monitor available

›Severe chest pain

›Confusion or fainting

›Inability to swallow saliva or drooling

›Severe neck swelling or stiffness

›Severe headache with weakness or vision changes

›Call clinic within 24 to 48 hours

›Fever lasting more than 3 days

›Symptoms worsening after initial improvement

›Severe ear pain or drainage

›Sinus pain with fever and worsening congestion

›Cough lasting more than 3 weeks

›Medication cautions

›Avoid decongestants if uncontrolled high blood pressure or significant heart rhythm history

›Do not use honey under 1 year of age

›Avoid OTC cough and cold combination products in young children per local guidance

12References/r12

Clinical guidelines and evidence sources

›Primary guidance sources

›CDC outpatient antibiotic stewardship for respiratory infections

›IDSA guideline for group A streptococcal pharyngitis

›IDSA guideline for acute bacterial rhinosinusitis

›ATS and IDSA guideline for community acquired pneumonia

›CDC influenza antiviral guidance

›Diagnostic decision tools

›Centor and McIsaac criteria for streptococcal pharyngitis risk stratification

›CURB-65 or CRB-65 for pneumonia severity support

›Safety references

›Pediatric cough and cold medication safety advisories

›Benzonatate pediatric toxicity warnings

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.