Self-limited viral infection of nose, sinuses, pharynx, larynx; usually rhinovirus, coronavirus, influenza.
History taking
- • Sore throat, rhinorrhoea, nasal congestion, sneezing, mild cough
- • Low-grade fever, malaise, headache; duration <10 days
- • Sick contacts, vaccination status
Examination
- • Erythematous pharynx, nasal mucosa congestion
- • Cervical lymphadenopathy (mild)
- • Chest clear; no consolidation
Red flags
- • Unilateral facial pain/swelling (sinusitis with complication)
- • Drooling, stridor, trismus (epiglottitis, peritonsillar abscess)
- • Symptoms >10 days or worsening after initial improvement
Differential diagnosis
- • Acute bacterial pharyngitis (GAS), influenza, COVID-19
- • Allergic rhinitis, acute sinusitis
- • Infectious mononucleosis
Recommended investigations
- • Usually clinical; no tests required
- • Rapid strep / throat swab if Centor ≥3
- • COVID/influenza PCR in selected cases
Diagnosis
- • Clinical diagnosis based on duration and self-limited course
Initial treatment / management
- • Symptomatic: paracetamol, warm saline gargles, steam inhalation, hydration, rest
- • Antihistamines/decongestants for symptom relief (short-term)
- • Antibiotics NOT routine; reserve for bacterial pharyngitis or sinusitis
Prescription examples
- • Tab Paracetamol 500 mg PO TDS PRN
- • Tab Cetirizine 10 mg PO HS x 3–5 d
- • Steam inhalation BD x 5 d; salt-water gargles QDS
- • If GAS: Tab Amoxicillin 500 mg PO TDS x 10 d (or Penicillin V)
Follow-up advice
- • Review if symptoms persist >10 days or worsening
Patient counselling
- • Hand hygiene, cough etiquette, isolation while symptomatic
- • Avoid antibiotics unless prescribed
- • Warning signs: high fever, breathlessness, ear pain
Referral criteria
- • Suspected epiglottitis, peritonsillar abscess, complicated sinusitis
Clinical pearls
- • Most URTIs resolve within 7–10 days without antibiotics
- • Green nasal discharge alone does not indicate bacterial infection
- • Persistent symptoms >10 days suggest secondary bacterial sinusitis
References
- • IDSA Guidelines: Acute Bacterial Rhinosinusitis 2012
- • NICE NG79: Sinusitis (acute)
Educational outpatient guide — verify against local guidelines before clinical use.
