[Guideline] Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH. Diagnosis and management of group A streptococcal pharyngitis: a practice guideline. Infectious Diseases Society of America. Clin Infect Dis. 1997 Sep. 25(3):574-83. [QxMD MEDLINE Link].
[Guideline] Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15. 55(10):1279-82. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul. 132(1):e262-80. [QxMD MEDLINE Link].
Utah Department of Health, Bureau of Epidemiology. Whooping Cough Sound Files. Utah Department of Health, Bureau of Epidemiology. Available at http://health.utah.gov/epi/diseases/pertussis/pertussis_sounds.htm. Accessed: November 29, 2012.
Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Clinical Features. Available at http://www.cdc.gov/pertussis/clinical/features.html. Accessed: October 27, 2013.
Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW Jr, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008 Apr 16. CD000243. [QxMD MEDLINE Link].
[Guideline] Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012 Apr. 54(8):e72-e112. [QxMD MEDLINE Link]. [Full Text].
Chung LP, Waterer GW. Genetic predisposition to respiratory infection and sepsis. Crit Rev Clin Lab Sci. 2011 Sep-Dec. 48(5-6):250-68. [QxMD MEDLINE Link].
Horby P, Nguyen NY, Dunstan SJ, Baillie JK. The role of host genetics in susceptibility to influenza: a systematic review. PLoS One. 2012. 7(3):e33180. [QxMD MEDLINE Link]. [Full Text].
Juno J, Fowke KR, Keynan Y. Immunogenetic factors associated with severe respiratory illness caused by zoonotic H1N1 and H5N1 influenza viruses. Clin Dev Immunol. 2012. 2012:797180. [QxMD MEDLINE Link]. [Full Text].
Meriluoto M, Hedman L, Tanner L, Simell V, Mäkinen M, Simell S, et al. Association of human bocavirus 1 infection with respiratory disease in childhood follow-up study, Finland. Emerg Infect Dis. 2012 Feb. 18(2):264-71. [QxMD MEDLINE Link]. [Full Text].
National Center for Infectious Diseases. Division of Bacterial and Mycotic Diseases. Haemophilus influenzae serotype b (Hib) disease. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hi-disease/clinicians.html. Accessed: November 29, 2012.
National Center for Infectious Diseases. Respiratory and Enteric Viruses Branch. Human parainfluenza viruses (HPIVs). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dvrd/revb/respiratory/hpivfeat.htm. Accessed: April 30, 2009.
[Guideline] Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009 Sep. 141(3 Suppl 2):S1-S31. [Full Text].
Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 Summary. 2008. Available at http://www.cdc.gov/nchs/data/nhsr/nhsr003.pdf.
Fagnan LJ. Acute sinusitis: a cost-effective approach to diagnosis and treatment. Am Fam Physician. 1998 Nov 15. 58(8):1795-802, 805-6. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention. Accessed April 30, 2009. Nonspecific upper respiratory tract infection. Available at http://www.cdc.gov/drugresistance/community/hcp-info-sheets/adult-nurti.pdf.
Isakson M, Hugosson S. Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults. J Laryngol Otol. 2011 Apr. 125(4):390-3. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention. Pertussis (Whooping Cough) Surveillance & Reporting. Available at http://www.cdc.gov/pertussis/surv-reporting.html. Accessed: June 12, 2012.
Bettiol S, Wang K, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, et al. Symptomatic treatment of the cough in whooping cough. Cochrane Database Syst Rev. 2012 May 16. 5:CD003257. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention. Outbreaks of respiratory illness mistakenly attributed to pertussis--New Hampshire, Massachusetts, and Tennessee, 2004-2006. MMWR Morb Mortal Wkly Rep. 2007 Aug 24. 56(33):837-42. [QxMD MEDLINE Link]. [Full Text].
CDC Centers for Disease Control and Prevention. Seasonal Influenza (Flu). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/flu/about/disease/index.htm. Accessed: June 12, 2012.
National Center for Infectious Diseases. Division of Bacterial and Mycotic Diseases. Epstein-Barr virus and infectious mononucleosis. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/diseases/ebv.htm. Accessed: April 30, 2009.
Centers for Disease Control and Prevention. CDC. Diphtheria. Centers for Disease Control and Prevention. CDC.gov. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/diptheria_t.htm. Accessed: June 12, 2012.
National Institute of Allergy and Infectious Diseases. Common Cold. National Institute of Allergy and Infectious Diseases. Available at http://www.niaid.nih.gov/topics/commoncold/Pages/default.aspx. Accessed: June 12, 2012.
Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics. 1991 Feb. 87(2):129-33. [QxMD MEDLINE Link].
CDC. Centers for Disease Control and Prevention. Seasonal Influenza (Flu): Seasonal Influenza-Associated Hospitalizations in the United States. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/flu/about/qa/hospital.htm. Accessed: November 29, 2012.
CDC. Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Clinical Complications. Available at http://www.cdc.gov/pertussis/clinical/complications.html. Accessed: June 12, 2012.
Arola M, Ruuskanen O, Ziegler T, Mertsola J, Näntö-Salonen K, Putto-Laurila A, et al. Clinical role of respiratory virus infection in acute otitis media. Pediatrics. 1990 Dec. 86(6):848-55. [QxMD MEDLINE Link].
Shulman ST. Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Curr Opin Pediatr. 2009 Feb. 21(1):127-30. [QxMD MEDLINE Link].
National Institute of Allergy and Infectious Diseases. Common Cold: Symptoms. Available at http://www.niaid.nih.gov/topics/commonCold/Pages/symptoms.aspx. Accessed: October 17, 2013.
[Guideline] Division of STD Prevention, CDC. Gonococcal Infections. Sexually Transmitted Diseases Treatment Guidelines, 2010. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/treatment/2010/gonococcal-infections.htm. Accessed: November 29, 2012.
Vincent MT, Celestin N, Hussain AN. Pharyngitis. Am Fam Physician. 2004 Mar 15. 69(6):1465-70. [QxMD MEDLINE Link].
CDC. Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Specimen Collection. Full text: http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full. Available at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html. Accessed: October 17, 2013.
Chow AW. Acute sinusitis: current status of etiologies, diagnosis, and treatment. Curr Clin Top Infect Dis. 2001. 21:31-63. [QxMD MEDLINE Link].
[Guideline] Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4. 55:1-94. [QxMD MEDLINE Link]. [Full Text].
CDC. Centers for Disease Control and Prevention. Pertussis (Whooping Cough): Diagnostic Testing. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/pertussis/clinical/diagnostic-testing/index.html. Accessed: November 29, 2012.
Adult epiglottitis: best practice of medicine [Internet database]. April, 2000;
Ragosta KG, Orr R, Detweiler MJ. Revisiting epiglottitis: a protocol--the value of lateral neck radiographs. J Am Osteopath Assoc. 1997 Apr. 97(4):227-9. [QxMD MEDLINE Link].
MacReady N. AAP Releases New Principles for URI Antibiotics. Medscape Medical News. Available at http://www.medscape.com/viewarticle/814533. Accessed: November 26, 2013.
Hersh AL, Jackson MA, Hicks LA. Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics. Pediatrics. 2013 Nov 18. [QxMD MEDLINE Link].
Little P, Moore M, Kelly J, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014 Mar 6. 348:g1606. [QxMD MEDLINE Link]. [Full Text].
Kissoon N, Mitchell I. Adverse effects of racemic epinephrine in epiglottitis. Pediatr Emerg Care. 1985 Sep. 1(3):143-4. [QxMD MEDLINE Link].
Weber JE, Chudnofsky CR, Younger JG, Larkin GL, Boczar M, Wilkerson MD, et al. A randomized comparison of helium-oxygen mixture (Heliox) and racemic epinephrine for the treatment of moderate to severe croup. Pediatrics. 2001 Jun. 107(6):E96. [QxMD MEDLINE Link].
[Guideline] Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):1S-23S. [QxMD MEDLINE Link].
Update: influenza activity - United States, September 28, 2008--January 31, 2009. MMWR Morb Mortal Wkly Rep. 2009 Feb 13. 58(5):115-9. [QxMD MEDLINE Link]. [Full Text].
van den Aardweg MT, Boonacker CW, Rovers MM, Hoes AW, Schilder AG. Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial. BMJ. 2011 Sep 6. 343:d5154. [QxMD MEDLINE Link]. [Full Text].
Harvey R, Hannan SA, Badia L, Scadding G. Nasal irrigation with saline (salt water) for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. January 24, 2007. Issue 3:[QxMD MEDLINE Link]. [Full Text].
Rabago D, Zgierska A, Mundt M, Barrett B, Bobula J, Maberry R. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract. 2002 Dec. 51(12):1049-55. [QxMD MEDLINE Link]. [Full Text].
Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007 Dec. 161(12):1140-6. [QxMD MEDLINE Link]. [Full Text].
Sharfstein JM, North M, Serwint JR. Over the counter but no longer under the radar--pediatric cough and cold medications. N Engl J Med. 2007 Dec 6. 357(23):2321-4. [QxMD MEDLINE Link].
Food and Drug Administration. FDA Statement Following CHPA's Announcement on Nonprescription Over-the-Counter Cough and Cold Medicines in Children. FDA: U.S. Food and Drug Administration. Available at http://www.fda.gov/bbs/topics/NEWS/2008/NEW01899.html. Accessed: May 10, 2009.
Wiklund L, Stierna P, Berglund R, Westrin KM, Tonnesson M. The efficacy of oxymetazoline administered with a nasal bellows container and combined with oral phenoxymethyl-penicillin in the treatment of acute maxillary sinusitis. Acta Otolaryngol Suppl. 1994. 515:57-64. [QxMD MEDLINE Link].
Hayden FG, Diamond L, Wood PB, Korts DC, Wecker MT. Effectiveness and safety of intranasal ipratropium bromide in common colds. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1996 Jul 15. 125(2):89-97. [QxMD MEDLINE Link].
Turner RB, Sperber SJ, Sorrentino JV, O'Connor RR, Rogers J, Batouli AR, et al. Effectiveness of clemastine fumarate for treatment of rhinorrhea and sneezing associated with the common cold. Clin Infect Dis. 1997 Oct. 25(4):824-30. [QxMD MEDLINE Link].
[Guideline] American Academy of Pediatrics. Clinical practice guideline: management of sinusitis. Pediatrics. 2001 Sep. 108(3):798-808. [QxMD MEDLINE Link].
Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev. 2007 Apr 18. CD005149. [QxMD MEDLINE Link].
American Academy of Pediatrics. Use of codeine- and dextromethorphan-containing cough remedies in children. American Academy of Pediatrics. Committee on Drugs. Pediatrics. 1997 Jun. 99(6):918-20. [QxMD MEDLINE Link].
Wing A, Villa-Roel C, Yeh B, Eskin B, Buckingham J, Rowe BH. Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature. Acad Emerg Med. 2010 May. 17(5):476-83. [QxMD MEDLINE Link].
Hirt M, Nobel S, Barron E. Zinc nasal gel for the treatment of common cold symptoms: a double-blind, placebo-controlled trial. Ear Nose Throat J. 2000 Oct. 79(10):778-80, 782. [QxMD MEDLINE Link].
United States Food and Drug Administration. Accessed June 16, 2009. Zicam cold remedy nasal products (Cold Remedy Nasal Gel, Cold Remedy Nasal Swabs, and Cold Remedy Saws, Kids Size). MedWatch Public Health Advisory. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm166996.htm.
Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev. 2011 Feb 16. 2:CD001364. [QxMD MEDLINE Link].
Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003 Dec 3. 290(21):2824-30. [QxMD MEDLINE Link].
Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, et al. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010 Dec 21. 153(12):769-77. [QxMD MEDLINE Link].
Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med. 2003 Apr. 9(2):285-98. [QxMD MEDLINE Link].
D'Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002 Jun 8. 324(7350):1361. [QxMD MEDLINE Link].
Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, et al. Position statement. Part one: Immune function and exercise. Exerc Immunol Rev. 2011. 17:6-63. [Full Text].
Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, et al. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR Recomm Rep. 2006 Dec 15. 55:1-37. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Workowski KA, Levine WC. Sexually transmitted diseases treatment guidelines: 2002 [Centers for Disease Control and Prevention Web site]. MMWR. 2002. 51(RR06):1-80. [Full Text].
American Academy of Pediatrics. Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Pediatrics. 2006 Mar. 117(3):965-78. [QxMD MEDLINE Link].
[Guideline] Safer Healthier PeopleCenters for Disease Control and Prevention. Pertussis: Summary of Vaccine Recommendations. Safer Healthier People. Available at http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm. Accessed: 02/10/2011.
US Food and Drug Administration. FDA Statement regarding azithromycin (Zithromax) and the risk of cardiovascular death. Available at http://www.fda.gov/Drugs/DrugSafety/ucm304372.htm. March 12, 2013; Accessed: February 17, 2017.

Media Gallery

Seasonal variation of selected upper respiratory tract infection pathogens. PIV is parainfluenza virus, RSV is respiratory syncytial virus, MPV is metapneumovirus, and Group A Strept is group A streptococcal disease.
CT scan of the sinuses demonstrates maxillary sinusitis. The left maxillary sinus is completely opacified (asterisk), and the right has mucosal thickening (arrow). Courtesy of Omar Lababede, MD, Cleveland Clinic Foundation.
Lateral neck radiograph demonstrates epiglottitis. Courtesy of Marilyn Goske, MD, Cleveland Clinic Foundation.
Gonococcal pharyngitis. Image credit: CDC Public Health Image Library (Flumara NJ, Hart G).
Strep throat with petechiae. CDC Public Health Image Library (Eichenwald HF).

of 5

Symptom	Allergy	URI	Influenza
Itchy, watery eyes	Common	Rare; conjunctivitis may occur with adenovirus	Soreness behind eyes, sometimes conjunctivitis
Nasal discharge	Common	Common	Common
Nasal congestion	Common	Common	Sometimes
Sneezing	Very common	Very common	Sometimes
Sore throat	Sometimes (postnasal drip); itchy throat	Very common	Sometimes
Cough	Sometimes	Common, mild to moderate, hacking cough	Common, dry cough, can be severe
Headache	Sometimes, facial pain	Rare	Common
Fever	Never	Rare in adults, possible in children	Very common, 100-102°F or higher (in young children), lasting 3-4 days; may have chills
Malaise	Sometimes	Sometimes	Very common
Fatigue, weakness	Sometimes	Sometimes	Very common, can last for weeks, extreme exhaustion early in course
Myalgias	Never	Slight	Very common, often severe
Duration	Weeks	3-14 days	7 days, followed by additional days of cough and fatigue

Upper Respiratory Tract Infection Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?