Upper respiratory tract infections

Acute upper respiratory tract infections (URTIs) are the commonest reason for patients to seek medical advice in the United Kingdom.

Pharyngitis/tonsillitis—this is caused by both bacterial and viral organisms, with sore throat often accompanied by fever, headache, and other symptoms, with or without enlarged and tender cervical lymph nodes, tonsillar erythema, and exudate. Investigations are not generally performed or required. Antibiotics have modest benefit, so for patients who are not unwell systemically the physician should either not prescribe, or use a delayed prescribing approach, advising the patient to wait for several days before collecting or using their prescription. The antibiotic of choice is probably penicillin V, with a short acting macrolide the second-line agent. The benefits of tonsillectomy in preventing recurrent sore throat are modest.

Acute rhinitis—causes nasal congestion and rhinorrhoea, mild malaise, sneezing, sore throat, variable loss of taste and smell, and usually recovers within two weeks. Oral and topical decongestants can help symptoms; echinacea and antibiotics can provide modest benefit.

Acute sinusitis—usually defined as an infection that lasts for less than three weeks, is an uncommon complication of coryzal illness and pharyngitis. Diagnosis based on a clinical risk score is as sensitive and specific as any other method. The effectiveness of antibiotic or other treatments is questionable.