Most upper respiratory tract infections are viral and require
symptomatic treatment. Antibiotics are commonly overused, even
though they should be thought of as being contra-indicated due to
the rapid emergence of antimicrobial resistance.
Acute bacterial sinusitis may complicate a viral URTI, but special
investigations for diagnosing acute sinusitis are unhelpful. Treatment
of pain and fever is usually the only non-specific measure that
helps. Antimicrobial treatment has become the chief treatment of
acute sinusitis, but there are studies that suggest that these agents
do not alter the course of the disease.
Since hearing loss is a risk of untreated and severe acute otitis
media, this condition is usually treated with antibiotics. However, a
recent Cochrane Review has concluded that the number of patients
needed to treat for one patient to benefit is 15.
The picture of itching, sneezing and profuse rhinorrhoea is typical
of early allergic rhinitis, but nasal obstruction becomes more
prominent over time, especially in perennial allergic rhinitis. This
gives rise to the classic facial appearance of children with perennial
allergic rhinitis and to the many complications. The most effective
therapy for allergic rhino-sinusitis involves topical nasal steroids.