ACUTE UPPER RESPIRATORY TRACT INFECTIONS: DIAGNOSTIC CHALLENGES AND THERAPEUTIC APPROACH

Krzysztof Kiełczewski; Barbara Fetner; Magdalena Dłużewska; Agnieszka Zaręba; Dawid Juszkiewicz; Konrad Adler; Patrycja Stankowska; Zuzanna Gebert; Ivanna Ilkiv; Agata Kucharska

doi:10.31435/ijitss.2(50).2026.5625

Authors

Krzysztof Kiełczewski Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0009-6159-4598
Barbara Fetner Medical University of Silesia, Faculty of Medical Sciences in Zabrze, Plac Traugutta 2, 41-800 Zabrze, Poland https://orcid.org/0009-0006-9413-9901
Magdalena Dłużewska Zespół Zakładów Opieki Zdrowotnej w Cieszynie, ul. Bielska 4, 43-400 Cieszyn, Poland https://orcid.org/0009-0006-5006-9112
Agnieszka Zaręba Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland https://orcid.org/0009-0001-9890-8310
Dawid Juszkiewicz Medical University of Gdansk, ul. Marii Skłodowskiej-Curie 3a, 80-210 Gdansk, Poland https://orcid.org/0009-0003-3392-8024
Konrad Adler Szpital Czerniakowski, Stępińska 19/25, 00-739 Warsaw, Poland https://orcid.org/0009-0006-9483-7072
Patrycja Stankowska Szpital Wolski im. dr Anny Gostyńskiej, ul. Marcina Kasprzaka 17, 01-211 Warsaw, Poland https://orcid.org/0009-0003-9100-1948
Zuzanna Gebert Międzyleski Szpital Specjalistyczny w Warszawie, ul. Bursztynowa 2, 04-749 Warsaw, Poland https://orcid.org/0009-0000-6169-5799
Ivanna Ilkiv Nowodworskie Centrum Medyczne, ul. Miodowa 2, 05-100 Nowy Dwór Mazowiecki, Poland https://orcid.org/0009-0008-4223-3976
Agata Kucharska Rey-Dent Gabinet Stomatologii Holistycznej, ul. Pustelnicka 18, 04-170 Warsaw, Poland https://orcid.org/0009-0009-9840-4911

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5625

Keywords:

Upper Respiratory Tract, Croup, Epiglottitis, Inflammation, Rhinovirus

Abstract

Background. Upper respiratory tract infections (URTIs) remain one of the most prevalent diagnoses in primary care. In medical practice most of them are self-limiting, therefore symptomatic management is the primary approach. Appropriate treatment is beneficial for the patient and for entire healthcare system.

Purpose. Aim of this study is to assess advantages and potential risks, when approaching treatment of acute upper respiratory tract infections based on particular etiology, while also highlighting the diagnostic challenges associated with identifying the causative pathogen.

Material and Methods. A narrative review was conducted using PubMed and Google Scholar databases. Main focus was put on recent clinical guidelines and research papers.

Results. The great diversity of etiological factors causing URTI and very similar clinical presentation means that more specific tests like PCR are required to properly distinguish pathogens. Furthermore, most URTI are of viral etiology, therefore causal treatment is rarely possible. Combining those facts with over-the-counter availability of NSAIDs means that COX-inhibitors became a staple in quick symptomatic relief.

Conclusion. Timely intervention in URTI leads to better outcomes and well-being of patients. In cases where etiology-based treatment is available, early intervention may contribute to reducing the infectious period and lowering the risk of hospitalization in high-risk patients. However, the potential increase in antimicrobial resistance should always be considered when making a treatment-related decision involving antibiotics. Objective medical tools, such as the Centor score may aid and quicken the decision process, while ensuring that antibiotics are administered when genuinely indicated.

References

Aregbesola, A., Tam, C. M., Kothari, A., Le, M. L., Ragheb, M., & Klassen, T. P. (2023). Glucocorticoids for croup in children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001955.pub5

Ashurst, J. V., Weiss, E., & Tristram, D. (2025). Streptococcal pharyngitis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK525997/

Azh, N., Barzkar, F., Motamed-Gorji, N., Pourvali-Talatappeh, P., Morady, Y., Vesal Azad, R., Ranjbar, M., & Baradaran, H. R. (2022). Nonsteroidal anti-inflammatory drugs in acute viral respiratory tract infections: An updated systematic review. Pharmacology Research & Perspectives, 10(2), e00925. https://doi.org/10.1002/prp2.925

Bassetti, M., Andreoni, M., Santus, P., & Scaglione, F. (2024). NSAIDs for early management of acute respiratory infections. Current Opinion in Infectious Diseases, 37(4), 304–311. https://doi.org/10.1097/QCO.0000000000001024

Bonomini, A., Mercorelli, B., & Loregian, A. (2025). Antiviral strategies against influenza virus: An update on approved and innovative therapeutic approaches. Cellular and Molecular Life Sciences. https://doi.org/10.1007/s00018-025-05611-1

Chung, Y. S., Lam, C. Y., Tan, P. H., Tsang, H. F., & Wong, S. C. (2024). Comprehensive review of COVID-19: Epidemiology, pathogenesis, advancement in diagnostic and detection techniques, and post-pandemic treatment strategies. International Journal of Molecular Sciences, 25(15), 8155. https://doi.org/10.3390/ijms25158155

Cowling, B. J., Lin, Y., & Ikematsu, H. (2025). Use of influenza antivirals to prevent transmission. The Journal of Infectious Diseases, 232(Supplement 3). https://doi.org/10.1093/infdis/jiaf116

Dowdy, R. A. E., & Cornelius, B. W. (2020). Medical management of epiglottitis. Anesthesia Progress, 67(2), 90–97. https://doi.org/10.2344/anpr-66-04-08

Duwe, S. C., Schmidt, B., Gärtner, B. C., Timm, J., Adams, O., Fickenscher, H., & Schmidtke, M. (2021). Prophylaxis and treatment of influenza: Options, antiviral susceptibility, and existing recommendations. GMS Infectious Diseases, 9, Doc02. https://doi.org/10.3205/id000071

Eccles, R. (2005). Understanding the symptoms of the common cold and influenza. The Lancet Infectious Diseases, 5(11), 718–725. https://doi.org/10.1016/S1473-3099(05)70270-X

Eccles, R. (2023). Common cold. Frontiers in Allergy, 4, 1224988. https://doi.org/10.3389/falgy.2023.1224988

Heikkinen, T., & Ruuskanen, O. (2006). Upper respiratory tract infection. In Encyclopedia of Respiratory Medicine (pp. 385–388). https://doi.org/10.1016/B0-12-370879-6/00416-6

Ibrahim, S., Siemieniuk, R. A. C., Oliveros, M. J., Islam, N., Díaz Martinez, J. P., Izcovich, A., Qasim, A., Zhao, Y., Zaror, C., Yao, L., Wang, Y., Vandvik, P. O., Roldan, Y., Rochwerg, B., Rada, G., Prasad, M., Pardo-Hernandez, H., Mustafa, R. A., Fashami, F. M., … Brignardello-Petersen, R. (2025). Drug treatments for mild or moderate COVID-19: Systematic review and network meta-analysis. BMJ, 389, e081165. https://doi.org/10.1136/bmj-2024-081165

Kadam, S. J., Daley, S. F., & Carr, B. (2025, June 2). Croup. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431070/

Kim, S. Y., Chang, Y. J., Cho, H. M., Hwang, Y. W., & Moon, Y. S. (2015). Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database of Systematic Reviews, 2015(9), CD006362. https://doi.org/10.1002/14651858.CD006362.pub4

Leung, A. K. C., Lam, J. M., & Barankin, B. (2024). Infectious mononucleosis: An updated review. Current Pediatric Reviews, 20(3), 305–322. https://doi.org/10.2174/1573396320666230801091558

McDermott, J., Sadeghi, N., Anasi, A., Mayer, B., & Ahmed, I. (2024). Managing epiglottitis in adults: A comprehensive case study. Cureus, 16(11), e73387. https://doi.org/10.7759/cureus.73387

Mustafa, Z., & Ghaffari, M. (2020). Diagnostic methods, clinical guidelines, and antibiotic treatment for group A streptococcal pharyngitis: A narrative review. Frontiers in Cellular and Infection Microbiology, 10, 563627. https://doi.org/10.3389/fcimb.2020.563627

Nicolas, M., Sun, S., Zorzi, F., Deplace, S., Jaafari, N., & Boussageon, R. (2023). Does the use of antipyretics prolong illness? A systematic review of the literature and meta-analysis on the effects of antipyretics in acute upper and lower respiratory tract infections. Infectious Diseases Now, 53(5), 104716. https://doi.org/10.1016/j.idnow.2023.104716

Qureshi, O., & Dua, A. (2024). COX inhibitors. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549795/

Romano, F. R., Anselmo-Lima, W. T., Kosugi, E. M., Sakano, E., Valera, F. C. P., Lessa, M., Roithmann, R., Pignatari, S., Felippu, A. W. D., Meotti, C. D., Barreto, C. C., Solé, D., Goudouris, E. S., Kuschnir, F. C., Pinna, F. R., Serpa, F. S., Matsumoto, G. R. L. L., Freire, G. S. M., Mello, J. F., … Piltcher, O. B. (2025). Rhinosinusitis: Evidence and experience—2024. Brazilian Journal of Otorhinolaryngology, 91(5), 101595. https://doi.org/10.1016/j.bjorl.2025.101595

Sahu, M., & Sahoo, P. R. (2021). Strawberry tongue in streptococcal pharyngitis. New England Journal of Medicine, 384(12), 1144. https://doi.org/10.1056/NEJMicm2026930

Sebo, P., Winkler, N. E., Moussa, M. A., Haller, D. M., & Maisonneuve, H. (2023). Nonpharmacological home remedies for upper respiratory tract infections: A cross-sectional study of primary care patients in Switzerland and France. Family Practice. https://doi.org/10.1093/fampra/cmad084

Silagy, C. A., & Campion, K. (1999). Effectiveness and role of zanamivir in the treatment of influenza infection. Annals of Medicine. https://doi.org/10.3109/07853899908995897

Smith, A., Riolobos, G. E., Biagi, M., Michalsen, A., Sadofsky, L., Herzeel, A., & Poucheret, P. (2025). Holistic care in mild upper respiratory tract infections (MURTIs): An approach to individualized care management. Drugs in Context. https://doi.org/10.7573/dic.2025-7-12

Tobin, E. H., Thomas, M., & Bomar, P. A. (2025, May 4). Upper respiratory tract infections with focus on the common cold. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532961/

Van Brusselen, D., Vlieghe, E., Schelstraete, P., De Meulder, F., Vandeputte, C., Garmyn, K., Laffut, W., & Van de Voorde, P. (2014). Streptococcal pharyngitis in children: To treat or not to treat? European Journal of Pediatrics, 173, 1275–1283. https://doi.org/10.1007/s00431-014-2395-2

Ward, M. A. (2002). Emergency department management of acute respiratory infections. Seminars in Respiratory Infections, 17(1), 65–71. https://doi.org/10.1053/srin.2002.31692

Wolford, R. W., Goyal, A., Belgam Syed, S. Y., & Schaefer, T. J. (2023, May 1). Pharyngitis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519550/

Yoon, Y. K., Park, C. S., Kim, J. W., Hwang, K., Lee, S. Y., Kim, T. H., Park, D. Y., Kim, H. J., Kim, D. Y., Lee, H. J., Shin, H. Y., You, Y. K., Park, D. A., & Kim, S. W. (2017). Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Infection & Chemotherapy, 49(4), 326–352. https://doi.org/10.3947/ic.2017.49.4.326