Managing URI
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| Upper Respiratory Infections include
colds and sore throats, and the sinus or ear infections that
sometimes follow them. Most of these infections are caused by
viruses, and will resolve within 7-10 days with symptomatic
treatment.
Symptoms often include nasal congestion and discharge, sore throat, a sensation of fullness or clicking in the ears, sneezing, coughing, fever up to 1010F, mild headache, and generalized aches and fatigue. Antibiotics are not effective against viral illnesses. Instead, treatment is aimed at relieving symptoms and supporting your bodys natural ability to fight infections. Rest conserves energy. While it is not necessary to remain in bed, it is important to get adequate sleep (7-9 hours), nap if you need to, and generally take it easy. Fluids help to liquefy and thin secretions so your body can eliminate them more effectively. Drinking 8-10 glasses of water or other clear fluids each day will help to reduce fever, and relieve congestion. Hot drinks, like tea or broth, will soothe a sore throat, as will ice chips or Popsicles. Humidity provided by a hot shower, a sink filled with hot water, or a cool mist vaporizer increasing the humidity in your room while you sleep can also make you more comfortable. Gargling with warm salt water (1/2tsp salt in 8oz. warm water) will soothe a sore throat, and reduce swelling and inflammation. Cough lozenges or sprays may be temporarily helpful. Herbal and vitamin supplements (still under study) which may have benefits in decreasing the severity or duration of viral symptoms include: Vitamin C, zinc gluconate lozenges (Cold-eze), and Echinacea standardized extract. All must be started as close to the onset of symptoms as possible, and should not be continued for longer than 7-10 days. Over-the-counter and prescription medications are used to relieve symptoms and reduce the risk of secondary infections, but read labels carefully, and use them according to package directions. Generic names, listed under ingredients on the label, are listed below. Some examples of brand names are given in italics. |
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- Many students choose multi-symptom medications because they are convenient. Read the label carefully to be sure you are getting the ingredients you need, for the symptoms you have, at an effective dose.
- Antipyretics and analgesics relieve fever and general discomfort. Examples include Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil).
- Decongestants relieve nasal and facial congestion, ear fullness, nasal discharge, and sore throat from postnasal drip. Pseudoephredrine (Sudafed) and phenylpropanolomine (usually found in combinations) are effective, but may disturb sleep. Nasal spray such as Oxymetazoline HCL 0.05% (Neosynephrine 12 hours, Afrin) provide rapid relief and will not interfere with sleep, but they must not be used for more than 3-5 days. Longer use can result in rebound swelling and increased symptoms.
- Antihistamines are intended to relieve allergy symptoms, but are included in many combination cold preparations because they may help to dry secretions. They can cause sedation. Over-the-counter antihistamines include chlorpheniramine, clemastine, diphenhydramine, and brompheniramine. Common antihistamine/decongestant combinations include Contac Continuous Action 12 hour, Tavist D, Drixoral Cold and Allergy.
- Expectorants and mucolytics help to liquefy secretions and relieve a dry cough. The most common expectorant is Guafenesin. It is in over-the-counter products like Robitussin, and prescription medications like Humibid. It is also sold in combination products with decongestants over the counter (Robitussin Liqui-Gels) and by prescription (Entex LA, Duravent).
- Cough Suppressants reduce the urge to cough. Since cough is the bodys mechanism to clear the airways, suppressants should be used only when a cough is non-productive or interferes with rest. They should never be used for more than 5 days. Cough suppressants are usually found in combination with expectorants. Dextromethorphan (Robitussin DM, Vicks 44, Duratuss DM) is an effective OTC cough suppressant. Prescription drugs include Tessalon, and narcotics such as hydrocodone (Hycodan) and codeine (Robitussin AC, Phenergan with codeine).
- Examples of multi-symptom medications include Theraflu (acetaminophen 1000mg, dextramethorphan 30mg, pseudoephedrine 60mg, and chlorpheniramine 4mg), Alka-seltzer Plus Cold and Flu (acetaminophen 325mg, dextromethorphan 10mg, phenypropanolamine 20mg, and chlorpheniramine 2mg) and Vicks Nyquil (acetaminophen 250mg, dextromethorphan 30mg, pseudoephedrine 30mg, and doxylamine succinate 12.5mg).
Signs and symptoms that require prompt re-evaluation:
- Fever greater than 1010F
- Increasing headache
- Confusion, lethargy, weakness
- Chest pain, tightness, or difficulty breathing
- Severe ear pain or drainage from the ear
- Worsening symptoms, or symptoms that last longer than 7 days.
Bacterial infections such as otitis media and sinusitis are usually preceded by viral upper respiratory infections, and might be avoided by use of decongestants. They occur when fluid in the facial sinuses or middle ear is unable to drain, and becomes secondarily infected.
Risk factors for bacterial infections include:
- past history of ear or sinus infections,
- allergies,
- smoking,
- smoke exposure, and
- impaired immune status.
Antibiotics are usually prescribed for these infections, but continuing all of the supportive care described above is essential.
Antibiotics must be used as directed in order to be effective. Be sure you know the name of your antibiotic, and that you are not allergic to it. If a particular medication is too costly, talk to your clinician about less expensive alternatives. Take the prescribed number of doses for the prescribed number of days, and call your clinician if you have a problem. EXPECT TO FEEL SOME IMPROVEMENT IN 36-72 HOURS, although you will need to continue the medication until it is used up.
Prevention of upper respiratory infections is a challenge. Viruses are easily spread by droplet infections (such as from infected people coughing and sneezing near you). These tiny drops are usually picked up on your hands and carried to the mucus membranes of your upper respiratory tract when you wipe or touch your eyes and nose. You can decrease your risk by:
- Maintaining a healthy immune system supported by good nutrition, regular exercise, and adequate sleep.
- Being tobacco-free and avoiding smoke- filled spaces.
- Staying away from closed crowded places.
- Frequent hand washing, and minimizing hand-face contact.