Acute nasopharyngitis: symptoms and treatment

Acute nasopharyngitis is the most common form of acute respiratory viral infection affecting the mucous membranes of the nose and nasopharynx. It is commonly referred to as a "cold." It is characterized by a runny nose, nasal congestion, sneezing, a scratchy or sore throat, and sometimes a cough and low-grade fever; the course is usually benign and self-limited. Most episodes resolve spontaneously within 7-10 days, although cough and postnasal drip may persist longer. [1]

There are a wide variety of pathogens: over 200 respiratory viruses can cause the common cold. Rhinoviruses are the most common; less common are seasonal coronaviruses (not SARS-CoV-2), parainfluenza, adenoviruses, enteroviruses, metapneumovirus, and others. This explains the frequent recurrence of episodes throughout the year and the impossibility of a "universal" cold vaccine. [2]

Transmission occurs through droplets and contact: talking, coughing, sneezing, and through hands and surfaces. The incubation period is short—approximately 2 days; peak contagiousness occurs in the first 2-3 days of illness. Understanding the transmission routes is the basis for prevention: hand hygiene, respiratory etiquette, and reducing close contact during peak symptom periods. [3]

Although a cold is a mild condition, it is important to distinguish it from influenza and COVID-19 (for which antiviral regimens are available for at-risk groups), and not to confuse it with bacterial complications (acute bacterial sinusitis, otitis media). The "golden rule": antibiotics are not indicated for uncomplicated acute nasopharyngitis. [4]

Code according to ICD-10 and ICD-11

In ICD-10, acute nasopharyngitis is coded J00 "Acute nasopharyngitis [common cold]." The notes section includes synonyms: "acute rhinitis," "corrhiza (acute)," and "infectious nasopharyngitis." This code is used for a typical clinical picture without signs of bacterial complications. [5]

In ICD-11, the diagnosis of "Acute nasopharyngitis" is classified under the respiratory disease category and is coded as CA00. A brief definition and navigation by exceptions are available in the ICD-11 browser (for example, chronic forms are coded separately, under CA09.x). Most countries are gradually transitioning from ICD-10 to ICD-11, so both standards may be found in medical documents. [6]

Table 1. Codes for acute nasopharyngitis

Classifier	Chapter	Code	Name
ICD-10	J00-J06 "Acute upper respiratory tract infections"	J00	Acute nasopharyngitis (common cold)
ICD-11	Respiratory diseases	CA00	Acute nasopharyngitis

Epidemiology

Acute nasopharyngitis is the most common cause of visits for upper respiratory tract infections worldwide. It occurs approximately 2-3 times per year in adults and 6-8 times per year in children, especially in preschool age. Seasonality is pronounced in autumn and winter in temperate latitudes. [7]

Rhinoviruses are confirmed in more than half of cold episodes, making them the leading etiologic agent of the "common" runny nose. Other viruses vary significantly by season and year, which is reflected in increases in incidence. [8]

In young children, nasopharyngitis is more often complicated by otitis media: prospective observations show the development of acute otitis media or middle ear effusion in 30% or more of episodes; in infants and preschoolers, this risk is higher than in schoolchildren. This should be taken into account during observation. [9]

Global estimates of the burden of upper respiratory tract infections confirm that the highest incidence rates occur in children under 2 years of age, but these figures vary from year to year (e.g., due to pandemics and control measures). Therefore, local statistics may differ from global averages. [10]

Table 2. Epidemiological landmarks

Indicator	Rating / fact
Frequency in adults	2-3 episodes per year
Frequency in children	6-8 episodes per year
Leading pathogen	Rhinovirus (more than 50% of episodes)
Seasonality	Autumn-winter in temperate latitudes
Frequency of otitis in children with acute respiratory infections	≈ 30% of episodes are complicated by AOM/effusion

Reasons

The etiologic spectrum includes more than 200 viruses. Rhinoviruses are the most common, followed by "common" human coronaviruses, parainfluenza, adenoviruses, enteroviruses (including EV-D68), and metapneumovirus. This viral diversity explains why we get sick repeatedly and why there is no single, universal vaccine against the common cold. [11]

Rhinoviruses are not only the most common cause of nasopharyngitis but also a frequent trigger for asthma exacerbations. Most rhinovirus infections are mild, especially in immunocompetent adults; severe cases are more common in the elderly, those with compromised immune systems, and those with chronic respiratory diseases. [12]

Infection occurs through airborne droplets and contact: viral particles are transmitted by coughing/sneezing, close-range conversation, and through hands and objects. When they come into contact with the mucous membranes of the eyes, nose, or mouth, they initiate infection; standard hand hygiene measures and respiratory etiquette reduce the risk. [13]

Bacteria play no role in uncomplicated colds, but a viral infection can predispose to bacterial complications (acute bacterial rhinosinusitis, acute otitis media). These are complications, not the initial "bacterial onset" of the cold. [14]

Risk factors

Preschool-aged children are more likely to become ill due to their immature immune system and close contact within groups. Having a preschool-aged child in the family increases the frequency of episodes in adult household members—this is a typical "family cluster." [15]

Working in high-density settings (schools, daycares, public transportation, open-plan offices) increases the risk of infection. Seasonal peaks in respiratory virus activity exacerbate this effect. [16]

Chronic respiratory diseases (bronchial asthma, chronic obstructive pulmonary disease), older age, and immunodeficiency are associated with a more severe course and risk of complications. In these conditions, a cold often triggers an exacerbation of the underlying disease. [17]

Sleep deprivation and stress are associated with increased susceptibility to colds, while dry indoor air is associated with severe congestion and discomfort. These factors are modifiable and are considered in preventative measures. [18]

Table 3. Risk factors and what to do about them

Factor	Why does it increase the risk?	What helps?
Childhood, kindergarten	Immature immunity, close contacts	Hygiene, etiquette training, ventilation
Close contacts in adults	Easy transmission by droplets/contact	Hands, mask if you have symptoms, sick leave at its peak
Chronic diseases, age	Higher risk of severe course	Early self-help, observation, action plan
Dry air, little sleep	Decreased local protection	Humidification 40-60%, sleep mode

Pathogenesis

The virus adheres to the epithelium of the nose and nasopharynx, penetrates cells, and triggers an innate immune response. Most symptoms are associated not with direct cytopathy, but with inflammatory mediators: vasodilation and increased vascular permeability cause swelling, mucus hypersecretion, and a feeling of congestion. [19]

Rhinoviruses possess several unique characteristics: optimal replication at nasal temperatures, multiple serotypes, and antigen variability. This facilitates repeated infections throughout life. There is evidence that rhinovirus can reduce mucociliary clearance and thereby predispose to secondary bacterial complications. [20]

In children, anatomical and physiological factors (narrow anastomoses, horizontal position of the auditory tube) contribute to the spread of inflammation to the middle ear, which explains the high incidence of otitis media associated with acute respiratory infections. In adults, rhinosinusitis is more common, but in most cases it is viral and self-limited. [21]

Immune memory to many pathogens is partial and short-lived, so episodes recur. However, in healthy individuals, the frequency of severe illnesses decreases over time due to cross-immune "preparation" and behavioral preventative skills. [22]

Symptoms

Classic symptoms include a runny nose, congestion, sneezing, a scratchy or sore throat, cough, headache, and low-grade fever. Sputum and nasal mucus often change color from clear to yellowish-green on the 2nd or 3rd day—this is a normal progression and not necessarily a sign of bacteria. [23]

For most people, symptoms subside by days 7-10, but postnasal drip and cough may persist longer. Children are more likely to experience fever and irritability; adults are more likely to experience fatigue and sleep disturbances due to congestion. [24]

Severe symptoms (high fever, severe facial/tooth pain, shortness of breath) are atypical and should prompt consideration of an alternative diagnosis or complication, especially in the first 24 hours of illness. [25]

Rhinovirus infection in asthmatic patients can cause wheezing and increased coughing, which is a common cause of exacerbations and requires a personalized asthma treatment plan. [26]

Classification, forms and stages

In clinical practice, acute nasopharyngitis is classified as an acute upper respiratory tract infection. Etiology includes viral (the vast majority) and viral with bacterial complications (acute bacterial rhinosinusitis, acute otitis media). Bacterial "runny nose" as a primary condition is rare. [27]

Based on the course of the disease, the following are conventionally distinguished: uncomplicated colds; colds with exacerbation of chronic diseases (asthma, chronic obstructive pulmonary disease); colds with local complications of the ENT organs. This division helps determine monitoring tactics and indications for additional interventions. [28]

For clarity, the stages are discussed as early (intense watery discharge, sneezing), peak (congestion, decreased sense of smell, change in mucus color), and recovery (reduction of congestion, residual cough). This reflects the dynamics of inflammation and secretion. [29]

In children and the elderly, the clinical presentation may be atypical: in young children, fever and refusal to eat; in the elderly, mild symptoms with marked weakness. This requires a lower threshold for consultation. [30]

Complications and consequences

Most often in children, acute otitis media is the most common; the risk increases in younger age groups and with certain viruses (e.g., respiratory syncytial virus). The reported frequencies vary from 10% to 50% of ARI episodes, and in some cohorts, around 33%. [31]

In adults, acute rhinosinusitis is possible: in the vast majority of cases, it is viral and transient, but in a smaller proportion of cases, acute bacterial rhinosinusitis develops, which requires different approaches (see the "Diagnostics" section). Spread to the lower respiratory tract is rare and more common in high-risk groups. [32]

In patients with asthma, the common cold is the leading trigger for exacerbations. Timely adjustment of inhalation therapy and early initiation of an "action plan" are key to preventing hospitalizations. [33]

Indirect consequences include missed work and school leave, decreased productivity, and economic losses. Proper self-care and avoidance of unnecessary antibiotics reduce both individual and population risks. [34]

Table 4. Frequent complications and action guidelines

Complication	Who has it more often?	What to look out for	What to do
Acute otitis media	Preschool children	Ear pain, fever, crying at night	ENT examination, treatment according to guidelines
Acute bacterial rhinosinusitis	Adults, after 10 days of symptoms	Pain in the face/teeth, purulent discharge, “two-wave” course	See recommendations, antibiotics according to indications
Asthma exacerbation	Patients with asthma	Wheezing, shortness of breath	Carry out a personal plan, contact if the situation worsens

When to see a doctor

Immediately - if severe shortness of breath, difficulty swallowing, persistently high fever, confusion, severe facial/ear pain, or a recurrence of symptoms after a brief improvement. These are signs of a possible complication or alternative diagnosis. [35]

You should seek medical attention on a planned basis if the symptoms do not improve by the 10th day, if the runny nose is accompanied by severe pain in the sinus area, if the child has signs of otitis, or if the disease is more severe than usual for you. [36]

For people at risk (the elderly, pregnant women, patients with chronic diseases, immunocompromised) it is appropriate to discuss the action plan in advance and assess the need for influenza/COVID-19 testing at each episode, as etiotropic regimens are available for them. [37]

If in doubt, especially during flu season or after exposure to COVID-19, it is appropriate to get tested: antivirals are more effective early on, and antibiotics are not a treatment for colds. [38]

Diagnostics

Step 1. Clinical assessment. The doctor collects a medical history (contacts, timing, and symptom dynamics) and examines the nasopharynx and ears. For a classic uncomplicated cold, laboratory tests are not necessary. The goal is to eliminate "red flags" and signs of complications. [39]

Step 2. Distinguish between a viral cold and acute bacterial rhinosinusitis. A bacterial process is indicated by a duration of more than 10 days without improvement, a "two-wave" course, severe facial pain, and purulent discharge. In all other cases, a viral diagnosis is present. [40]

Step 3. Influenza and COVID-19 testing for high-risk groups or during routine clinical visits. If you are at risk for severe illness, early laboratory verification provides a chance for etiotropic treatment (oseltamivir for influenza; antiviral drugs for COVID-19, as indicated). [41]

Step 4. Instrumental diagnostics. X-ray/CT scan of the paranasal sinuses is not indicated for uncomplicated colds; imaging is necessary for complicated cases or atypia. Otoscopy in children is for early detection of otitis. Nasal endoscopy is helpful for prolonged congestion and frequent relapses. [42]

Table 5. What, when and why in diagnostics

Situation	What to do	For what
Typical cold ≤10 days	No tests	Self-limiting flow
Suspected bacterial sinusitis	Clinic, visualization if necessary	Decide on an antibiotic
Risk groups/flu and COVID-19 season	Rapid test/PCR	Early etiotropic treatment
Ear pain in a child	Otoscopy	Exclude/confirm otitis

Differential diagnosis

Influenza and COVID-19 often have a sudden onset, accompanied by severe aches and pains, high fever, and extreme weakness. Colds are usually milder. Testing is important in vulnerable groups, as etiotropic treatment is available. [43]

Allergic rhinitis. It is characterized by itchy nose and eyes, erratic sneezing, watery discharge without fever, and is associated with allergens. Long-lasting symptoms are common. A cold has an acute onset, systemic signs of infection, and resolves within 1-2 weeks. [44]

Acute bacterial rhinosinusitis. Duration >10 days without improvement, "two-wave" course, severe facial/teeth pain, purulent discharge are key markers. Most "runny noses" lasting up to 10 days are viral. [45]

Acute otitis media in children. May accompany a cold; ear pain, crying at night, and fever are warning signs. Otoscopy and treatment according to specialist recommendations are required. [46]

Treatment

The goal of therapy is to relieve symptoms, reduce the impact on quality of life, and prevent unnecessary antibiotic use. For adults with uncomplicated colds, the basic treatments include rest, adequate hydration, saline nasal irrigation, and, if necessary, painkillers and antipyretics. For children, age-appropriate treatment and safe dosages are recommended. [47]

Painkillers (paracetamol, ibuprofen) reduce headaches, aches and pains, and sore throats, and promote sleep. Ibuprofen is generally not used in children under 6 months; aspirin is not used in children due to the risk of Reye's syndrome. The choice of medication and dosage depends on age and underlying medical conditions. [48]

Nasal saline solutions (isotonic and hypertonic) are safe, improve mucociliary clearance, and may reduce the duration of symptoms and the need for over-the-counter medications. Recent data indicate the benefit of regular irrigation and gargling with saline solutions during the first days of illness. [49]

Antihistamine + decongestant + analgesic combinations in adults and adolescents provide moderate relief of combined symptoms (runny nose, sneezing, headache). The effect is modest and comes with a risk of side effects (drowsiness, dry mouth, cardiovascular effects with decongestants), so they should be used briefly and judiciously, avoiding use in young children. [50]

Intranasal ipratropium bromide is indicated specifically for "runny" rhinorrhea: it reduces discharge but does not relieve congestion. The evidence base includes randomized trials and reviews; the drug is used topically, for a short course, especially when "runny nose" is the primary complaint. [51]

Honey can reduce coughs in children over 1 year old and in adults; it's best taken at night, for example, in a warm drink. Cough syrups with multi-component formulas don't show convincing benefits for colds, and some are contraindicated for children. Opt for simple and safe solutions. [52]

Zinc: Modern systematic reviews agree that prophylactic use does not prevent colds, and when taken within the first 24 hours of illness, some forms (usually acetate in lozenges, with a total of 75-100 mg of elemental zinc per day) can moderately shorten the duration of an episode, but are associated with an unfavorable taste, nausea, and variable effects. This is an "optional" option for adults without contraindications, not for long-term use. [53]

Intranasal glucocorticosteroids are not routinely needed for the common cold (their role is in allergic rhinitis). Nasal decongestants are acceptable for short-term use (up to 5-7 days) to relieve congestion; with longer use, there is a risk of rebound congestion (rhinomedication). For children, age-appropriate formulations are used. [54]

Antibiotics are not used for uncomplicated colds: they do not shorten the duration of symptoms or prevent complications, but they increase the risk of side effects and resistance. Antibiotic therapy is considered only if clinical criteria for acute bacterial rhinosinusitis or confirmed otitis media are met. [55]

Risk groups (the elderly, pregnant women, and patients with serious comorbid conditions) with cold symptoms should consider testing for influenza/COVID-19: etiotropic antivirals (oseltamivir, nirmatrelvir/ritonavir, etc.) are effective in the early stages. The common cold itself does not have specific antiviral agents, so the strategy is support and monitoring for warning signs. [56]

Table 6. Symptomatic remedies: what for what

Symptom	What helps?	Comments
Pain/aches/fever	Paracetamol, ibuprofen	Age-related doses, contraindications
Watery rhinorrhea	Intranasal ipratropium	Reduces leakage, does not relieve congestion
Congestion	A short course of vasoconstrictors	≤5-7 days, strictly according to the instructions
General symptoms	Combo AGP+DKG±ANL in adults	Modest effect, risk of side effects
Cough at night	Honey (over 1 year old)	A simple and safe option
To everyone	Salt irrigation	Improves comfort and ground clearance

Prevention

The foundations of prevention include hand hygiene, respiratory etiquette (coughing/sneezing into a tissue or the crook of your elbow), ventilating rooms, and avoiding work/school during peak symptoms. These measures reduce the transmission of any respiratory viruses, including those that cause colds. [57]

During the flu and SARS-CoV-2 season, vaccination and early testing for symptoms are important for at-risk groups, as this opens the door to targeted treatment for these infections. There is no vaccine for the "common cold"—there are too many pathogens. [58]

Maintaining adequate humidity at home (around 40-60%), getting enough sleep, and reducing stress can reduce the susceptibility and severity of symptoms. Simple behavioral measures are often more effective than "magic" pills. [59]

Saline irrigations and rinses as "upper respiratory hygiene" are safe and can be used at the first symptoms - there is evidence of a reduction in duration and a decrease in the need for over-the-counter medications. [60]

Forecast

In the vast majority of people, acute nasopharyngitis resolves on its own within 7-10 days. Individual symptoms (cough, postnasal drip, decreased sense of smell) may linger for weeks but gradually subside without specific treatment. [61]

Severe outcomes are rare and are usually related to age, immunodeficiency, or comorbidities. Sleep and performance impairments contribute most to the deterioration in quality of life; these can be reduced with appropriate symptomatic therapy. [62]

Preventing unnecessary antibiotic prescriptions is important for both patients and the healthcare system: it reduces side effects and slows the growth of resistance. If a complication is suspected, the approach changes—an in-person assessment is indicated. [63]

Children frequently experience ear infections, but with timely treatment, the prognosis is favorable. In patients with asthma, cold episodes require a personalized action plan to prevent exacerbations. [64]

FAQ

How long does a cold last?
Typically 7-10 days; coughing and back pain may persist longer, gradually decreasing. If there is no improvement by day 10 or if it gets worse after a "clear window," consult a doctor. [65]

Do you need antibiotics for a common cold?
No. A cold is a viral infection. Antibiotics do not shorten the duration or prevent complications, and side effects and resistance are real risks. The exception is confirmed bacterial complications. [66]

Is there anything that can speed up recovery?
Sleep, fluids, saline irrigation, and painkillers when needed help. For some adults, zinc acetate lozenges, started within the first 24 hours, moderately shorten the duration, but the effect is variable and there are side effects. [67]

What nasal drops should I use?
Short courses of decongestants (up to 5-7 days) are acceptable for relieving congestion. Intranasal ipratropium helps with runny noses. Saline sprays and rinses are safe and suitable for everyone. Avoid using decongestants for longer than a week, as this can increase the risk of drug-induced rhinitis. [68]

When should I get tested?
For a typical uncomplicated cold, testing is not necessary. Influenza and COVID-19 testing are appropriate for high-risk groups and typical clinical symptoms, as early antiviral therapy is then possible. Sinus imaging is only necessary in cases of complications. [69]

Table 7. Home remedies for colds (quick reminder)

Step	What to do	Comment
1	Sleep and drink	Recovery base
2	Salt irrigation 2-4 times a day	Safe, suitable for children
3	Pain reliever if needed	By age doses
4	Short-term decongestant (≤5-7 days)	Only in case of severe congestion
5	Honey at night (over 1 year)	For cough/sore throat

Table 8. Red flags - when to see a doctor immediately

Sign	Possible cause
Shortness of breath, chest pain, confusion	Infection control, alternative diagnosis
Severe pain in the face/teeth >10 days	Acute bacterial rhinosinusitis
Severe ear pain and fever in a child	Acute otitis media
"Two-wave" current	Bacterial complication