Common Viral Infections - Indiana

by S. Kelly last updated Jun 19, 2020 06:38 PM

Indiana State Department of Health
Common viral infections and considerations for appropriate antibiotic use

State Guidelines, adapted from CDC Adult Treatment Recommendations

Acute rhinosinusitis

See References 1-2


  • 90–98% of rhinosinusitis cases are viral, and antibiotics are not guaranteed to help even if the causative agent is bacterial


If a bacterial infection is established:

  • Watchful waiting is encouraged for uncomplicated cases for which reliable follow-up is available.
  • Amoxicillin or amoxicillin/clavulanate is the recommended first-line therapy.
  • Macrolides such as azithromycin are not recommended due to high levels of Streptococcus pneumoniae antibiotic resistance (~40%).
  • For penicillin-allergic patients, doxycycline or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) are recommended as alternative agents.

Acute uncomplicated bronchitis

See References 3-5


  • Cough is the most common symptom for which adult patients visit their primary care provider, and acute bronchitis is the most common diagnosis in these patients. Viral pathogens are the causative agents in most cases.
  • Colored sputum does not indicate bacterial infection.


  • Routine treatment of uncomplicated acute bronchitis with antibiotics is not recommended, regardless of cough duration.

Options for symptomatic therapy include:

  • Cough suppressants (codeine, dextromethorphan); first-generation antihistamines (diphenhydramine); decongestants (pseudoephedrine and phenylephrine).

Common cold/non-specific URI

Non-specific upper respiratory tract infection. See References 6-7.


  • The common cold is the third most frequent diagnosis in office visits, and most adults experience two to four colds annually.
  • At least 200 viruses can cause the common cold.


  • Use of antibiotics is NOT recommended to treat the common cold.
  • Decongestants (pseudoephedrine and phenylephrine) combined with a first-generation antihistamine may provide short-term symptom relief of nasal symptoms and cough.
  • Non-steroidal anti-inflammatory drugs can be given to relieve symptoms. Evidence is lacking to support antihistamines (as monotherapy), opioids, intranasal corticosteroids, and nasal saline irrigation as effective treatments for cold symptom relief.


See References 8-9.


  • Group A beta-hemolytic streptococcal (GAS) infection is the only common indication for antibiotic therapy for sore throat cases.
  • Only 5–10% of adult sore throat cases are caused by GAS. A rapid antigen detection test is necessary to distinguish GAS pharyngitis from other causes.


  • Antibiotic treatment is NOT recommended for patients with negative GAS RADT results.
  • Amoxicillin and penicillin V remain first-line therapy due to their reliable antibiotic activity against GAS.
  • For penicillin-allergic patients, cephalexin, clindamycin, or macrolides are recommended.


  1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (updated): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-39.
  2. Chow AW, Benninger MS, Itzhak B, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.
  3. Albert RH. Diagnosis and treatment of acute bronchitis. Am Fam Physician. 2010;82(11):1345-50.
  4. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl).
  5. Gonzales R, Bartlett JG, Besser RE, et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: Background. Ann Intern Med. 2001;134(6):521-9.
  6. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153-9.
  7. Pratter MR. Cough and the common cold: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl): 72S-74S.
  8. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-102.
  9. Cooper RJ, Hoffman JR, Bartlett JG, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Ann Intern Med. 2001;134(6):509-17.