URTI Clinical Protocol
Evidence-based management for Pediatric & Adult Respiratory Infections (2025/2026).
🚨 Urgent Red Flags: Refer to ED
- Neonates (< 1 month): Any fever requires immediate referral TRO neonatal sepsis.
- Respiratory Distress: Tachypnea (RR >60 in <2mo; >50 in <1yr; >40 in <5yrs)[cite: 25].
- Clinical Instability: Altered conscious level, stridor, or severe dehydration[cite: 44, 219].
- Chest Pain: Typical symptoms + normal ECG still require ED referral for serial monitoring[cite: 64, 219].
👶 Pediatric Symptomatic Check
Fever (> 2 months)
Paracetamol: 15mg/kg QID (Fast: Wt x 0.3mL of 250mg/5ml)[cite: 31, 39].
Ibuprofen: 5mg/kg TDS (Avoid in active fever/dehydration)[cite: 35, 44].
Cough & Cold
Carbocisteine: 10mg/kg TDS (Fast: Wt x 0.5mL of 100mg/5ml)[cite: 31, 39].
Bromhexine: 0.3mg/kg TDS (Fast: Wt x 0.375mL of 4mg/5ml)[cite: 31, 39].
Cetirizine: 0.25mg/kg OD (For runny nose > 2yo)[cite: 31, 39].
👨💼 Adult Symptomatic Check
General Relief
- Fever: Paracetamol 1g QID (Avoid NSAIDs if bleeding risk)[cite: 48, 64].
- Runny Nose: Cetirizine 10mg OD (Drowsy) or Loratadine 10mg OD (Non-drowsy)[cite: 48, 49].
- Sore Throat: Lozenges, Thymol gargle, or Throat spray.
Cough Logic
- Productive: Bromhexine 8mg TDS or Syrup Benadryl 10ml TDS[cite: 48, 64].
- Dry: Copastin 10mg TDS or Syrup Sedilix 10ml TDS.
- Chronic (>2w): CXR & Sputum C&S; rule out ACE-inhibitor side effects.
💊 Antibiotic Decision Tool
| Diagnosis | First Choice (Adult) |
|---|---|
| Tonsillitis / Pharyngitis | Amoxicillin 500mg TDS or Erythromycin 800mg BD[cite: 78]. |
| Rhinosinusitis | Amoxicillin 500mg TDS or Augmentin 625mg TDS[cite: 78]. |
| Otitis Media / Pneumonia | Amoxicillin 500mg TDS or Augmentin 625mg TDS[cite: 78]. |
*Note: Based on National Antimicrobial Guideline 2024[cite: 79].
📢 Patient Education & Counseling
- Hydration: Encourage frequent small sips of water or ORS[cite: 39, 44].
- Monitoring: Return immediately if child develops blue lips, indrawing of chest, or becomes lethargic[cite: 44].
- Hygiene: Hand washing and isolation for notifiable diseases (e.g., Measles, HFMD)[cite: 163, 168].