Upper Respiratory Infection Management (IDSA/CDC)

Algorithm Steps

1. ▶

   Start

   Upper Respiratory Symptoms

   Cough, congestion, sore throat, rhinorrhea

   1. ◆

      Decision

      Primary Symptom Pattern

      Determine syndrome

      1. ●

         Action

         Pharyngitis/Sore Throat

         Assess for Group A Strep

         • Use Centor/McIsaac criteria
         • Fever, tonsillar exudates, tender anterior cervical nodes, no cough
         • Score 0-1: No testing, symptomatic care
         • Score 2-3: Rapid strep test
         • Score 4+: Empiric treatment or test
         1. ◆

            Decision

            Strep Test Result

            Rapid strep or culture

            1. ●

               Action

               GAS Pharyngitis

               Antibiotic treatment

               • Penicillin V 500mg BID x 10 days
               • Amoxicillin 500mg BID x 10 days
               • PCN allergy: Azithromycin 500mg day 1, 250mg days 2-5
               • Symptomatic improvement expected 24-48h
               1. ●

                  Action

                  Symptomatic Treatment

                  All URI syndromes

                  • Hydration and rest
                  • Acetaminophen or ibuprofen for pain/fever
                  • Topical/oral decongestants (<3 days)
                  • Honey for cough (age >1 year)
                  • Nasal saline irrigation
                  1. ●

                     Action

                     Return Precautions

                     When to seek care

                     • Symptoms worsening after day 3
                     • Not improved by day 10
                     • High fever >102°F
                     • Difficulty breathing
                     • Severe headache, facial swelling
            2. ●

               Action

               Viral Pharyngitis

               Symptomatic care only

               • No antibiotics indicated
               • Salt water gargles
               • Lozenges, NSAIDs for pain
               • Most improve in 7 days
      2. ●

         Action

         Rhinosinusitis

         Viral vs bacterial distinction

         • <10 days: Likely viral
         • ≥10 days without improvement: Consider bacterial
         • Severe symptoms (high fever, facial pain) >3 days: Consider bacterial
         • Double-worsening: Improving then worse
         1. ◆

            Decision

            Bacterial Sinusitis Criteria Met?

            Symptoms ≥10 days OR severe

            1. ●

               Action

               Bacterial Sinusitis Treatment

               Antibiotic options

               • First-line: Amoxicillin-clavulanate 875/125mg BID x 5-7 days
               • Alt: Doxycycline 100mg BID x 5-7 days
               • PCN allergy: Doxycycline or respiratory fluoroquinolone
               • Decongestants and saline rinses adjunctive
               1. ●

                  Action

                  Watchful Waiting Option

                  Delayed prescribing strategy

                  • Appropriate for mild bacterial sinusitis
                  • Give prescription with instructions to fill if not better in 7 days
                  • Reduces antibiotic use by 50%
                  • Ensure patient understands worsening signs
      3. ●

         Action

         Acute Bronchitis

         Almost always viral

         • Cough predominant, may last 2-3 weeks
         • No pneumonia signs (focal findings, dyspnea)
         • Antibiotics NOT recommended
         • Cough suppressants, honey (adults)
         • Inhaler if bronchospasm present