Upper respiratory tract infection (common cold)
Viral infection of the upper airway (rhinovirus, coronavirus, RSV…)
Overview
A self-limiting viral infection of the upper airway — the common cold. Coryza, sore throat, cough and malaise lasting about a week. The clinical job is reassurance and safety-netting, NOT antibiotics, and recognising the few who need more (e.g. secondary bacterial infection, the unwell infant).
Recognise
- Nasal congestion/discharge, sneezing, sore throat, cough, mild fever and malaise
- Self-limiting over ~1 week (cough can linger longer); spread by droplets/contact
- Commonest reason for primary-care attendance and inappropriate antibiotic requests
Red flags
- Breathing difficulty, persistent high fever, dehydration (especially infants), or features of a complication (pneumonia, AOM, sinusitis, epiglottitis)
Differentials & how to tell them apart
Investigations
Clinical; none routinely. Consider testing/escalation only if a complication or alternative diagnosis is suspected.
Management
Symptomatic care + safety-netting; NO antibiotics
- 1Reassure: self-limiting over about a week. Advise fluids, rest and simple analgesia; safety-net for complications.Gate: No ANTIBIOTICS for a simple viral URTI — antibiotics do not change the course and drive resistance; reserve escalation for a genuine bacterial complication (pneumonia, AOM, bacterial sinusitis) or the unwell infant
- 2Reassess if not improving by ~10 days or if complications develop; consider influenza/COVID testing and antivirals where indicated for at-risk groups.
Key points
Self-limiting; the whole skill is NOT prescribing antibiotics and safety-netting. Distinguish from bacterial tonsillitis (Centor/FeverPAIN) and from influenza (abrupt, systemic).
Monitor & prognosis
Resolution by ~1 week; complications.
Self-limiting.
Source: NICE CKS Common cold