Rhinitis and rhinopharyngitis (common cold)

Definition and usual course

Rhinitis is inflammation of the nasal mucosa; rhinopharyngitis involves the nose and pharynx. Most cases are viral, benign, and self-limited.

The condition can still be the first presentation of another infection such as measles or influenza, or it may be followed by bacterial complications such as acute otitis media or sinusitis.

Purulent nasal discharge alone does not prove bacterial infection and is not by itself an indication for antibiotics.

Clinical features and assessment

• Nasal discharge, blocked nose, sneezing, sore throat, fever, cough, watery eyes, tiredness, reduced appetite, and diarrhoea in infants may occur.
• Assess hydration, feeding, respiratory effort, oxygenation if unwell, fever pattern, ear pain, throat pain, facial pain, rash, and exposure history.
• In children under 5 years, routinely check the tympanic membranes when possible because otitis media may accompany or complicate a cold.
• Consider influenza, measles, COVID-like viral illness, pertussis, pneumonia, sinusitis, otitis media, and asthma when symptoms or local epidemiology point beyond a simple cold.

Treatment

Treatment is symptomatic. Antibiotics are not recommended for uncomplicated rhinitis or rhinopharyngitis because they do not shorten recovery and do not prevent complications.

• Clear nasal obstruction with 0.9% sodium chloride. For a child, lay the child on the back with the head turned to one side and instil saline into each nostril.
• Continue feeding and breastfeeding. Clear the nose before feeds when obstruction interferes with sucking.
• Encourage fluids and monitor urine output when fever or poor intake is present.
• Use paracetamol for fever or throat soreness for 2 to 3 days when needed, checking age, weight, liver disease, and other contraindications. Ibuprofen may be used when age and safety profile allow.
• Avoid unnecessary cough-and-cold combinations in young children because benefits are limited and adverse effects can occur.

Complications and referral

• Complications include acute otitis media, sinusitis, dehydration from poor feeding, wheeze or asthma exacerbation, pneumonia, and missed measles or influenza.
• Refer or review urgently for breathing difficulty, chest indrawing, cyanosis, altered consciousness, inability to feed, dehydration, persistent high fever, severe ear pain, mastoid swelling, severe throat pain, facial or periorbital swelling, rash with fever, or symptoms lasting longer than expected.
• Young infants, severe malnutrition, chronic cardiopulmonary disease, immune suppression, and poor access to follow-up lower the threshold for assessment.

Prevention and counselling

• Prevention depends on hand hygiene, respiratory etiquette, ventilation, avoiding smoke exposure, vaccination according to local programme, breastfeeding support, and reducing exposure of young infants to symptomatic contacts.
• Explain that nasal discharge may become thick or coloured during viral illness and does not automatically mean antibiotics are needed.
• Give clear return advice for worsening breathing, poor feeding, reduced urine, persistent fever, ear pain, facial pain, or new rash.