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Respiratory Illness in Children and Adults, Diagnosis and Treatment of

ICSI Respiratory Illness for Children and Adults guideline is now available for public comment. It covers the following conditions:

  • Viral Upper-Respiratory Infections,
  • Pharyngitis,
  • Non-Infectious Rhinitis and
  • Acute Sinusitis.

This guideline has undergone major revisions, especially with regards to Group A Strep Pharyngitis and Sinusitis.

Group A Strep: The recommendations are to use shared decision-making for testing AND treatment of Group A strep. The evidence for treating Group A strep with antibiotics is inconclusive.

Acute sinusitis: The recommendation is to start with symptomatic care as initial treatment and use shared decision-making to determine whether antibiotics are indicated.

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This Guideline is Currently under Revision

Revision Date: January 2013
Fourth Edition

Guideline Summary

Scope and Target Population

The Diagnosis and Treatment of Respiratory Illness in Children and Adults guideline encompasses acute conditions in infants greater than three months, children, adolescents and adults who are in good health.


  1. Increase the percentage of patients diagnosed with viral upper-respiratory infection who receive appropriate treatment.
  2. Reduce excessive antibiotic treatment through decreased empiric treatment of patients with strep pharyngitis.
  3. Increase the use of recommended first-line medications for patients diagnosed with strep pharyngitis.
  4. Increase patient/caregiver knowledge about strep pharyngitis and pharyngitis care.
  5. Decrease the use of injectable corticosteroid therapy for patients diagnosed with allergic rhinitis.

Clinical Highlights

  • Patients and/or parents of children presenting or calling with symptoms suggestive of the common cold should be evaluated for other symptoms and the presence of more serious illness.
  • The primary treatment of viral upper-respiratory infection is education based; education is to take place in the clinic, on the telephone, at the work site and in newsletters. Patients and/or parents should receive home care and call-back instructions.
  • Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness.
  • Diagnosis of group A beta streptococcal pharyngitis should be made by laboratory testing rather than clinically.
  • Patients should be educated on strep pharyngitis, including the importance of following the prescribed medication regimen, use of home remedies to relieve symptoms, actions to take if symptoms worsen, and the importance of eliminating close contact with family members or visitors to the home while group A beta streptococcal may be contagious.
  • Prescribe intranasal steroids for moderate or severe allergic rhinitis.
  • Treat patients diagnosed as having allergic seasonal rhinitis with prophylactic medications and educate about avoidance activities.
  • Consider limited coronal computed tomography scan of sinuses and/or referral to ear, nose and throat clinician for patients when three weeks of antibiotic therapy have not produced a response in sinusitis treatment.

Additional Background

The goal of the guideline is threefold: education to assist patients to be competent and comfortable with home care of respiratory illness; to assist medical personnel to differentiate respiratory illness from more severe illness; to improve the appropriateness of care and antibiotic use for respiratory illness while decreasing the cost of that care.