Upper Respiratory Infections and Acute Bronchitis

Abstract

Upper respiratory infections include uncomplicated upper respiratory infections also known as the "common cold," acute otitis media, pharyngitis/tonsillitis, and acute sinusitis. These conditions, along with acute bronchitis, are very common illnesses that are seen often in outpatient settings and are widely treated with antibiotics; in fact, they are the primary indications for outpatient antibiotic prescriptions. These conditions tend to have overlapping clinical characteristics, yet evidence regarding the utility of antimicrobial treatments varies across different infections. UNCOMPLICATED UPPER RESPIRATDRY INFECTION/COMMON COLD Clinical DescriptionUncomplicated upper respiratory infections (URis) are characterized by rhinorrhea, nasal congestion, sneezing, sore or "scratchy" throat, and cough ( 1 ). The incubation period varies between 48 and 72 h. In some cases a low-grade fever is present, but temperature elevation in adults is rare. The early symptoms may be minimal and limited to malaise and nasal symptoms. The nasal discharge is initially clear and watery. There is a subsequent transition period where the nasal discharge becomes viscous, opaque, and discolored (white, yellow, green) (2). The color of the secretions is not predictive of a bacterial infection. The clinical presentation is similar in both adults and children. The episode tends to be self-limited. The median duration of a cold is 1 wk, with most patients improving by the 1Oth day, but lingering symptoms may last up to 2 wk. EpidemiologyURis, or the "common cold," are exactly as the name implies-common. URis are consistently one of the five most common diagnoses in ambulatory physician office visits (3-5). Adults have two to four URis annually and children in day care have as many as six or seven (6, 7). Although URis are mild, self-limited, and of short duration, they are a leading cause of acute morbidity and of industrial and school absenteeism (8). Each year, URis account for 170 million d of restricted activity, 23 million d of school absence, and 18 million d of work absence.