Respiratory

Supportive care only (rest, fluids, analgesics/antipyretics, saline, decongestants); antibiotics are not indicated for viral URI. Educate on the expected self-limited course of 7-10 days.

The common cold is caused by viruses, so antibiotics provide no benefit and add risk of adverse effects, resistance, and C. difficile. Reserve antibiotics for documented bacterial infection.

Bacterial is suggested by symptoms persisting >=10 days without improvement, double-worsening (initial improvement then worsening), or severe onset (high fever >=39C plus purulent discharge/facial pain) for 3-4 days.

Amoxicillin-clavulanate is first-line. Doxycycline is an alternative for penicillin allergy. Watchful waiting for 7 days is appropriate for many cases before starting antibiotics.

Refer for recurrent acute sinusitis (>=4 episodes/year), chronic sinusitis, treatment failure, or complications (orbital/periorbital swelling, vision change, severe headache, altered mental status) suggesting intracranial/orbital spread.

It estimates the likelihood of group A strep pharyngitis using: fever >38C, tonsillar exudate, tender anterior cervical nodes, absence of cough, and age (McIsaac adds age points; subtracts for age >=45).