A Guide to Upper Respiratory Tract Infections: Causes, Treatment, and Warning Signs

Introduction

Upper respiratory tract infections, or URTIs, are a common concern for people of all ages. These infections can leave you feeling under the weather, but understanding their causes, knowing how to treat them, and recognizing red flags can help you manage URTIs more effectively.

Causes of Upper Respiratory Tract Infections

URTIs can be caused by various factors, but the most common culprits are viruses. Here's what you need to know:

1. Viruses: The Usual Suspects

Viruses are responsible for the majority (81.7%) of URTIs¹. There are more than 200 different viruses that are responsible for cold and flu symptoms. Of these, the most common viral infections include:

Rhinovirus: This virus is the primary cause of the common cold. It spreads easily through droplets from coughs and sneezes.

Influenza (Flu): The flu virus can cause severe respiratory symptoms, and it's crucial to get vaccinated to protect yourself particularly if you are at risk for severe infections.

In Australia, the influenza vaccine is recommended for everyone aged 6 months and over and is available free for²:

• -        Children aged 6-months to 5 years
• -        Pregnant women
• -        People aged 65-years and over
• -        Aboriginal and Torres Strait Islander people
• -        People with certain medical conditions

Adenoviruses: Most often infect the airways leading to cold-like symptoms including sore throat, sneezing, running noses, coughing, headache, muscle aches and pains and fever.

Coronaviruses: Some coronaviruses, like the common ones causing colds, can lead to URTIs, but severe strains like COVID-19 can also affect the upper respiratory tract. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that all people aged 5-years and older are vaccinated against COVID-19, and children aged 6-months to 5-years who have specific health conditions that place them at higher risk of severe infection³.

2. Bacterial Infections: Less Common but Still Significant

While viruses dominate URTIs, bacteria can also play a role. Streptococcus pneumoniae (‘strep throat’) and Haemophilus influenzae are examples of bacteria that can cause respiratory infections. Both of these infections are usually self-limiting and often resolve completely by themselves within a few days.

Interestingly, if coughing is the predominant feature your infection is more likely to be viral than bacterial. In patients with bacterial throat infections cough is usually not a major feature compared to the sore throat. Viral infections are also more likely to present with muscle aches, pains and fatigue.

Treatment Options for URTIs

Managing URTIs involves addressing symptoms, practicing good hygiene, and sometimes, seeking medical help.

1. Self-Care and Symptom Relief

Rest: Give your body the time it needs to heal by getting plenty of rest.

Hydration: Staying hydrated can help thin mucus and ease congestion.

Humidifiers: Adding moisture to the air can soothe irritated airways.

Over-the-Counter Medications: Non-prescription cold and flu remedies and simple analgesics (paracetamol and/or ibuprofen) can alleviate symptoms like fever, congestion, and sore throat. Be sure to follow dosing instructions carefully.

2. Antiviral Medications

For specific viral infections like influenza, antiviral medications (such as Oseltamivir or Tamiflu) may be prescribed by your healthcare provider. The most common side effects of Tamiflu are diarrhoea, nausea, vomiting and abdominal pains. Tamiflu also cannot be taken by pregnant or breastfeeding women. Tamiflu is not available on the Australian PBS^4,5 (private prescription only) and treatment is usually reserved for patients who are experiencing or at risk of severe illness.

3. Antibiotics

Antibiotics are not effective against viruses and most upper respiratory infections are caused by viruses. For the few infections that are caused by bacteria (e.g. ‘strep throat’) the infection often resolves by itself within a few days. Side effects from antibiotics include diarrhoea (you kill all the digestive systems good bacteria), thrush, rashes, allergies, antimicrobial resistance (meaning the antibiotic may not be effective when you next need it), and some life-threatening conditions such as anaphylaxis. Unless you are at risk of acute rheumatic fever, antibiotics are not indicated in the treatment of upper respiratory tract infections and will not help you get better faster⁶.

Recognizing Red Flags

While most URTIs are mild and resolve on their own, some signs should not be ignored:

1. High Fever

If your fever is consistently high (above 38.9°C), it could be a sign of a more severe infection.

2. Difficulty Breathing

If you experience severe shortness of breath, wheezing, or chest pain, seek medical attention immediately.

3. Productive Cough

A productive cough with thick phlegm, particularly if combined with fevers and shortness of breath, may be a sign of a lower respiratory tract infection. Seek medical attention immediately.

4. Bluish Lips or Face

This could indicate a lack of oxygen in your blood and requires urgent medical care.

5. Confusion

In rare cases, severe URTIs can lead to neurological symptoms. Don't hesitate to seek immediate help if you or a loved one experiences confusion, seizures, or altered mental status.

Conclusion

Upper respiratory tract infections are a part of life, but knowing how to identify their causes, treat symptoms, and recognize red flags can make a significant difference in your recovery. Remember to practice good hygiene, get vaccinated when appropriate, and don't hesitate to consult a healthcare professional if you have concerns about your URTI. By staying informed and taking proper care, you can better navigate the challenges these infections bring and safeguard your respiratory health.

References

1. Tang J, Chen J, He T, Jiang Z, Zhou J, Hu B, Yang S. Diversity of upper respiratory tract infections and prevalence of Streptococcus pneumoniae colonization among patients with fever and flu-like symptoms. BMC Infect Dis. 2019 Jan 7;19(1):24. doi: 10.1186/s12879-018-3662-z. PMID: 30616564; PMCID: PMC6323860.

2. The Australian Immunisation Handbook. Influenza (flu). Influenza (flu) | The Australian Immunisation Handbook (health.gov.au) [accessed 19/09/2023].

3. Department of Health and Aged Care. Clinical recommendations for COVID-19 vaccines. Clinical recommendations for COVID-19 vaccines | Australian Government Department of Health and Aged Care [accessed 19/09/2023].

4. Australian Medicines Handbook Pty Ltd. Oseltamivir. 2023 https://amhonline.amh.net.au [accessed 19/09/2023].

5. Australian Government Department of Health and Aged Care. The pharmaceutical benefits scheme. 2023. https://www.pbs.gov.au [accessed 19/09/2023].

6. Australian Therapeutic Guidelines. Approach to managing pharyngitis and tonsillitis in patients not at high risk of acute rheumatic fever. https://tgldcdp.tg.org.au [accessed 19/09/2023]