Acute catarrhal rhinitis — symptoms, causes, diagnosis and treatment

Acute catarrhal rhinitis is an acute inflammation of the nasal mucosa, most often representing one of the first manifestations of a viral upper respiratory tract infection. More than 200 respiratory viruses can cause the clinical picture of the common cold; rhinoviruses are the most frequent pathogens, but similar inflammation can also be caused by seasonal coronaviruses, adenoviruses, enteroviruses, parainfluenza viruses, respiratory syncytial virus, metapneumovirus, influenza viruses, and SARS-CoV-2. The pathogen is transmitted through aerosol particles, saliva droplets, close contact, and contaminated hands. Exposure to cold does not itself cause a viral infection; however, cold and dry air, sleep deprivation, physical exhaustion, tobacco smoke, and other irritants may temporarily impair the mucociliary defense of the mucosa and facilitate the development of illness after infection. The virus enters respiratory epithelial cells and triggers the release of inflammatory mediators, vasodilation, swelling of the nasal turbinates, increased secretion, and a temporary slowing of epithelial ciliary activity. The initial symptoms are dryness, burning or tickling in the nose, sneezing, nasal congestion, and clear watery discharge. This may be followed by reduced sense of smell, a nasal voice, postnasal drainage, throat irritation, sore throat, cough, tearing, ear fullness, headache, weakness, body aches, chills, and a moderate rise in body temperature. Yellow or greenish mucus after several days does not by itself prove a bacterial infection and is not an indication for antibiotics. The main target tissue remains the mucosa of the nose and nasopharynx, but inflammation may spread to the paranasal sinuses, auditory tubes, middle ear, larynx, trachea, and bronchi. The illness occurs more frequently in children; marked swelling interferes more significantly with sleep and feeding, while the anatomically shorter auditory tube increases the likelihood of otitis media. In infants, even relatively mild nasal swelling can substantially impair breathing during feeding. In adults, the illness is usually self-limiting. In older adults, fever may remain low despite a more serious infection, while the risks of dehydration, medication-related complications, and decompensation of cardiovascular and bronchopulmonary diseases are higher. Symptoms usually peak on the second or third day and then gradually diminish; nasal congestion, discharge, and cough may sometimes persist for 10–14 days, but they should progressively improve.

How to determine whether you have acute catarrhal rhinitis: the most characteristic pattern is the rapid onset of sneezing, bilateral nasal congestion, clear or gradually thickening secretions, throat irritation, and mild general malaise after contact with an ill person. In adults, body temperature may remain normal or mildly elevated. For an initial self-assessment, measure body temperature, pulse rate, and respiratory rate, and assess the ability to drink normally, urination, the severity of weakness, and the presence of pain in the face, ear, or chest. If there is shortness of breath, severe comorbidity, or concern that the infection may have spread, measuring oxygen saturation can be useful. If the illness began with pronounced body aches, high fever, severe weakness, or there was confirmed exposure, testing for influenza should be performed, especially in patients from risk groups, because these infections cannot be reliably distinguished by symptoms alone, while specific antiviral treatment is most effective when started promptly. A physician usually makes the diagnosis based on the medical history and examination of the nose, nasopharynx, ears, and lungs; anterior rhinoscopy reveals swelling, mucosal hyperemia, and secretions. Blood tests, bacterial cultures, radiography, and computed tomography are not required for ordinary uncomplicated rhinitis. Allergic rhinitis is more likely when there is intense nasal itching, paroxysmal sneezing, tearing, itchy eyes, a clear association with an allergen, and no infectious malaise. Influenza more often begins suddenly with high fever, pronounced body aches, and weakness. Findings that raise greater suspicion of bacterial rhinosinusitis include no improvement for more than 10 days, severe unilateral facial or dental pain, high fever, and renewed worsening after initial improvement. Unilateral foul-smelling discharge in a child requires exclusion of a nasal foreign body. Persistent unilateral drainage of clear fluid, especially after head trauma or surgery, requires exclusion of cerebrospinal fluid leakage. Prolonged nasal congestion after the use of vasoconstrictor drops may be a manifestation of rhinitis medicamentosa.

Red flags: immediate medical attention is required for difficult or rapid breathing, bluish discoloration of the lips, chest pain, an oxygen saturation of 94% or lower at rest, or a noticeable decline from the person’s usual level — these findings may indicate lower respiratory tract involvement, bronchospasm, pneumonia, or respiratory failure. Altered consciousness, seizures, a sudden extremely severe headache, neck stiffness, repeated vomiting, weakness of a limb, speech disturbance, or visual impairment require emergency medical services and evaluation for central nervous system involvement. Swelling of the eyelid or tissues around the eye, pain with eye movement, double vision, reduced vision, and protrusion of the eyeball are dangerous because they may indicate an orbital complication of sinusitis; urgent assessment by an otorhinolaryngologist and ophthalmologist is required. Severe unilateral facial pain, rapidly increasing facial swelling, purulent discharge, and a severely impaired general condition require evaluation for bacterial rhinosinusitis and its complications. Signs of dehydration include a marked reduction in urination, a dry tongue, inability to drink, pronounced dizziness, drowsiness, absence of tears in a child, and a sunken anterior fontanelle in an infant. A temperature of 38 °C or higher in a child younger than three months requires immediate medical assessment. At any age, reasons to seek medical care include fever lasting more than four days, symptoms without improvement for more than 10 days, or renewed worsening after a period of recovery. Severe ear pain, discharge from the ear canal, or a sudden reduction in hearing requires examination by an ENT physician. In an infant, refusal to feed, episodes of apnea, intercostal retractions, and inability to breathe while sucking are dangerous signs. Pregnant women, older adults, and patients with immunodeficiency, cancer, severe asthma, COPD, diabetes mellitus, or chronic diseases of the heart, liver, or kidneys should seek medical evaluation earlier rather than waiting for pronounced deterioration.

Methods of initial self-care for acute catarrhal rhinitis: during the first few days, adequate sleep, reduced intensive physical activity, and avoidance of exercise in the presence of fever, marked weakness, shortness of breath, or tachycardia are necessary. Complete inactivity is not required if body temperature is normal; light everyday activity is acceptable according to how the person feels. Sleeping with the head slightly elevated is more comfortable and reduces postnasal drainage and nighttime congestion. The room should be aired regularly while avoiding a direct stream of cold air. An approximate air temperature of 18–22 °C and relative humidity of 40–60% are appropriate; excessive humidity is undesirable because it promotes mold growth. Smoking, vaping, aerosol fragrances, smoke, dust, aggressive cleaning agents, and alcohol should be completely avoided. Food should remain normal but easy to tolerate: warm soups, cereals, eggs, fish, fermented dairy products if well tolerated, vegetables, and soft fruits. There is no need to force a sick person to eat; maintaining fluid intake is more important. Very hot, scalding, excessively spicy foods and strong alcohol increase mucosal irritation. An adult without fluid restrictions may drink water, unsweetened compote, warm tea, or broth at room temperature or moderately warm, in portions of 150–250 mL every one to two hours while awake, guided by thirst and a light-yellow urine color. Forcing several additional liters of fluid provides no benefit and may be dangerous. In heart or kidney failure, the fluid restriction prescribed by the physician should be followed; in diabetes, sweetened drinks should be avoided. For nasal cleansing, a commercially prepared sterile isotonic 0.9% sodium chloride solution or a properly prepared irrigation solution is preferred. An adult may use gentle irrigation with approximately 100–200 mL for each side of the nose once or twice daily, or a sterile saline spray as needed. The pressure should be low; the mouth is kept open during irrigation, and the head is tilted forward and slightly to the side. If the nose is completely obstructed, there is significant ear pain, frequent nosebleeds, or there has been recent surgery or trauma, irrigation should not be performed without medical advice. Only sterile, distilled, or previously boiled and cooled water is acceptable for irrigation — tap water must not be used directly because of the rare but extremely dangerous risk of introducing microorganisms. The irrigation device must be washed and completely dried after each procedure.

In infants, several drops of sterile isotonic solution are used instead of large-volume irrigation, after which softened secretions are gently removed with an aspirator before feeding, without inserting the tip deeply or creating strong suction. The nose should be blown without excessive pressure, clearing the nostrils one at a time. If the skin beneath the nose becomes irritated, it should be rinsed with water, gently patted dry with a soft tissue, and protected with a thin layer of a neutral topical product; greasy ointments should not be inserted deeply into the nose. Steam inhalation over boiling water is not recommended because of the risk of burns, especially in children. Onion, garlic, or lemon juice, concentrated essential oils, alcohol-based tinctures, hydrogen peroxide, and other irritating solutions must not be instilled into the nose: they damage the epithelium and worsen inflammation. The sinus area should not be heated without medical advice when there is severe unilateral pain, high fever, marked swelling, or suspected purulent complications. Body temperature, breathing, ability to drink, urination, pain intensity, the overall trend of symptoms, and the appearance of renewed deterioration should be monitored daily. If there is no clear improvement within 7–10 days, or if improvement is followed by a new rise in temperature and worsening pain, medical evaluation is required.

Stages and possible progression of acute catarrhal rhinitis: the incubation period depends on the pathogen and most often lasts several days. Traditionally, a phase of dry irritation, a phase of serous discharge, and a phase of thicker mucous or mucopurulent secretion are distinguished; however, these stages may overlap, and some patients may not experience every phase. White, yellow, or green secretions on the third to fifth day often reflect the accumulation of inflammatory cells and changes in the water content of the mucus rather than the obligatory addition of a bacterial infection. In most people, the illness ends with complete recovery of the mucosa. A reliable percentage for the absence of recurrent rhinitis over a two-year period has not been established: a previous infection does not protect against the many other respiratory viruses. Recurrences are promoted by frequent exposure in childcare settings, work involving contact with many people, sleep deprivation, smoking, air pollution, allergic rhinitis, a deviated nasal septum, adenoid hypertrophy, chronic sinus inflammation, immunodeficiency, and inadequate control of diabetes mellitus. Symptoms that recur or persist for months should not automatically be called a “prolonged cold” — allergy, rhinitis medicamentosa, chronic rhinosinusitis, polyps, anatomical obstruction, or exposure to irritants should be investigated. Possible complications include acute rhinosinusitis, auditory tube dysfunction, otitis media, exacerbation of asthma or COPD, laryngitis, tracheobronchitis, and, much less commonly, pneumonia. Dehydration may occur in young children and older adults. Unjustified prolonged use of vasoconstrictor agents can cause rhinitis medicamentosa, in which the congestion is then perpetuated by the medication itself.

Integrative treatment methods for acute catarrhal rhinitis

The basis of the integrative approach is direct local treatment of the inflamed nasal mucosa together with systemic anti-inflammatory support. Additional agents are introduced only when the corresponding symptoms are present. Simultaneous use of all the products listed below is not required.

The central local component is ABP-153 oil infusion, which is used intranasally two to three times a day. The basic version without DMSO is intended primarily for mucous membranes and superficial or cavity-associated inflammatory processes. It comes into direct contact with the irritated epithelium, helps reduce inflammation, reactive swelling, and irritation, supports the protective barrier, and facilitates the removal of secretions.

ABP-153 should not be drawn deeply into the nasopharynx. Particular caution is required in people with swallowing disorders, pronounced gastroesophageal reflux, neurological disorders, or a tendency to aspirate. Menthol, camphor, borneol, eucalyptus, clove, and other active components may cause burning, sneezing, hyperemia, or a temporary increase in reactive congestion. Use should be discontinued if pronounced irritation, swelling, or bleeding develops.

Saline cleansing and water-based intranasal preparations are used before the oil infusion is applied. ABP-153 is used in a separate time window and should not be mixed with vasoconstrictors, hormonal agents, or other nasal products. ABP-153D is not required for acute catarrhal rhinitis because deep penetrative delivery with DMSO does not correspond to the main superficial target.

The principal systemic multicomponent preparation is Rhinitis and Rhinosinusitis Mixture Capsules, which are taken orally according to the established dosing regimen for the product. The formula is intended for systemic modulation of the inflammatory response, swelling, hypersecretion, and difficulty in nasal breathing.

The capsules should not automatically be combined with a large number of separate extracts if the same plants are already included in the mixture. The product is contraindicated in cases of individual hypersensitivity, exacerbation of peptic ulcer disease, severe decompensation of liver or kidney function, pregnancy, lactation, and in children below the age limit established by the manufacturer. Dyspepsia and allergic reactions are possible.

In cases of pronounced inflammation, swelling, body aches, headache or facial pain, and low-grade fever, Five Root Compound anti-inflammatory mixture may be used. This is a powdered mixture intended exclusively for oral administration. It is taken after meals, with the established daily amount divided into two or three doses. The powder is not used intranasally and is not added to solutions for nasal irrigation.

Experimental studies of the components of Five Root Compound have described effects on nitric oxide, inducible nitric oxide synthase, cyclooxygenase-2, prostaglandins, and pro-inflammatory cytokines. The formula does not have the direct mechanism of gastric mucosal injury, platelet function suppression, and reduction in renal blood flow established for nonselective NSAIDs; however, there are insufficient direct comparative clinical studies with NSAIDs.

For mild isolated rhinorrhea without pronounced pain, swelling, or a general inflammatory response, Five Root Compound is not essential. Excessive use may cause dyspepsia, abdominal pain, diarrhea, headache, and allergic reactions. Individual assessment is required during pregnancy, lactation, childhood, in liver and kidney disease, and when anticoagulants, antihypertensive agents, or other anti-inflammatory drugs are used at the same time.

A cooling gel patch is applied externally as an adjunct for elevated temperature and headache. The hydrogel provides gradual local cooling of the skin for several hours, but it does not affect the central mechanism of fever, does not destroy the virus, and does not replace necessary antipyretic therapy.

The patch should not be applied to damaged, inflamed, or irritated skin or in close proximity to the eyes. It should be removed if itching, rash, burning, or pronounced redness develops. Systemic drug interactions are not expected when it is used correctly as a topical product.

If throat irritation, dry cough, or hoarseness develops, “Cough and Hoarseness” boluses may be used. They contain amla, licorice, and honey and are intended to dissolve slowly in the mouth. Prolonged contact with the mucosa provides a soothing, mucoprotective, and local anti-inflammatory effect.

The boluses should not be used in young children or patients with impaired swallowing because of the risk of choking and aspiration. They are contraindicated in people with an allergy to honey and require caution in diabetes mellitus. With substantial or prolonged systemic exposure, licorice may cause sodium and fluid retention, increase blood pressure, cause edema, and reduce potassium concentration.

Particular caution is required in severe hypertension, heart or kidney failure, pronounced edema, and hypokalemia. Combining licorice with diuretics and systemic glucocorticosteroids increases potassium loss. Concurrent use with digoxin and certain antiarrhythmic medicines increases the risk of cardiac arrhythmias.

For concomitant headache or neck and occipital pain, Aromatic Cooling Oil Sukaya oil infusion may be used. The product is for external use only and is applied to intact skin over the temples, occiput, or neck two to three times a day. Menthol activates cold-sensitive TRPM8 receptors and provides a counterirritant analgesic effect.

Aromatic Cooling Oil Sukaya does not treat inflammation of the nasal mucosa, reduce viral load, or replace ABP-153. It must not be applied inside the nose, to mucous membranes, damaged skin, the eye area, or directly beneath the nostrils. Use should be discontinued if burning, tearing, or pronounced irritation develops.

A rational regimen may include ABP-153 as the main local treatment and Rhinitis and Rhinosinusitis Mixture Capsules as the systemic herbal formulation. Five Root Compound is added only when a pronounced inflammatory pain syndrome is present. The cooling gel patch is used for fever or headache, the boluses for cough and hoarseness, and Aromatic Cooling Oil Sukaya only for a separate headache or neck and occipital pain.

This program makes it possible to target inflammation, swelling, pathological secretion, and epithelial injury without unjustified escalation of vasoconstrictor medicines, systemic NSAIDs, and antibiotics. The plant origin of these products does not eliminate the possibility of allergy, dyspepsia, mucosal irritation, or drug interactions; therefore, the composition of the regimen is determined by the predominant symptoms, blood pressure, liver and kidney function, allergy history, and medications already being used.

What you need to know about standard protocols of modern medicine

There is no specific medicine capable of eliminating all viruses that cause ordinary acute catarrhal rhinitis. Standard treatment remains primarily symptomatic, and the choice of medicines depends on the predominant symptom, the patient’s age, and concomitant diseases. Antibiotics do not act against viruses and do not shorten the duration of uncomplicated viral rhinitis. If the clinical picture resembles influenza or COVID-19, especially in a patient from a risk group, testing and a separate assessment of indications for specific antiviral therapy are required.

Topical decongestants such as oxymetazoline and xylometazoline stimulate α-adrenergic receptors in the vessels of the nasal mucosa, reduce blood filling of the nasal turbinates, and temporarily restore nasal breathing. They do not destroy the virus, suppress its replication, or shorten the duration of the illness. Common adverse reactions include burning, dryness, irritation, crust formation, and nosebleeds. With systemic absorption, palpitations, tachycardia, increased blood pressure, headache, tremor, anxiety, and insomnia may occur.

Prolonged or excessively frequent use of decongestants causes reduced sensitivity of α-adrenergic receptors, ischemic epithelial injury, reactive vasodilation, and rhinitis medicamentosa. Once the effect of the medicine wears off, nasal congestion becomes worse than it was initially, prompting the patient to increase the frequency of administration and leading to persistent medication dependence. Long-term overuse may damage the ciliated epithelium and cause chronic dryness, bleeding, impaired mucociliary clearance, and persistent hypertrophy of the nasal turbinates.

Particular caution is required in uncontrolled arterial hypertension, cardiac arrhythmias, ischemic heart disease, hyperthyroidism, angle-closure glaucoma, and atrophic rhinitis. Combination with monoamine oxidase inhibitors, other sympathomimetics, and certain psychotropic medicines may cause a sharp rise in blood pressure and dangerous cardiovascular reactions. Several vasoconstrictor substances contained in different nasal and combination products must not be used simultaneously. In children and in pregnant or breastfeeding women, the medicine should be selected only after age restrictions and individual risks have been assessed.

Pseudoephedrine has a systemic sympathomimetic effect and may temporarily reduce nasal congestion, but compared with topical agents it more often causes tachycardia, increased blood pressure, arrhythmias, tremor, anxiety, irritability, insomnia, mucosal dryness, and urinary retention. It does not restore damaged epithelium and does not act against the viral infection.

Pseudoephedrine is contraindicated in severe or uncontrolled hypertension and in severe acute or chronic kidney disease. Particular caution is required in ischemic heart disease, arrhythmias, angle-closure glaucoma, hyperthyroidism, prostatic hyperplasia, pregnancy, and lactation. It must not be combined with monoamine oxidase inhibitors or other stimulant agents. Rare but severe cerebrovascular complications have been described, including posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome. A sudden thunderclap headache, seizures, confusion, or visual disturbances require immediate discontinuation of the medicine and emergency medical care.

Oral phenylephrine is included in many combination cold medicines, but its clinical effectiveness as a nasal decongestant at approved over-the-counter doses has not been convincingly demonstrated. Its presence increases the overall medication burden and may cause increased blood pressure, tachycardia, headache, anxiety, tremor, insomnia, and urinary retention without a comparably proven benefit. Of particular concern is the unnoticed duplication of phenylephrine in several powders, tablets, and syrups taken at the same time.

Intranasal ipratropium bromide blocks cholinergic stimulation of the glands and mainly reduces abundant watery nasal discharge. It has little effect on vascular swelling, sneezing, or congestion. Marked mucosal dryness, burning, crusting, blood-streaked mucus, and nosebleeds may occur. If the aerosol enters the eyes, it may cause pupil dilation, pain, blurred vision, and an acute attack of angle-closure glaucoma. Systemic anticholinergic reactions include palpitations, tachycardia, constipation, and urinary retention. Combination with other medicines that have anticholinergic effects increases mucosal dryness, visual disturbances, constipation, and urinary problems.

Paracetamol is used only when there is clinically significant fever, headache, muscle pain, or sore throat. It does not relieve nasal congestion and has little effect on peripheral inflammation of the mucosa. The principal danger of paracetamol is dose-dependent hepatic necrosis. Exceeding the total dose, alcohol consumption, fasting, inadequate nutrition, liver disease, and unnoticed use of several medicines containing paracetamol may lead to acute liver failure, impaired blood clotting, encephalopathy, coma, the need for liver transplantation, and death. During the first hours of severe poisoning, pronounced symptoms may be absent. Severe allergic and cutaneous reactions are also possible. Regular use together with warfarin may alter the anticoagulant effect, so the composition of all combination cold remedies should be checked before each dose.

Ibuprofen and other nonsteroidal anti-inflammatory drugs reduce pain, body aches, and fever but do not affect the cause of viral rhinitis. They can damage the mucosa of the stomach and intestines, cause erosions, ulcers, massive gastrointestinal bleeding, and perforation. Severe bleeding may sometimes develop without significant preceding pain.

NSAIDs reduce renal blood flow, promote sodium and fluid retention, increase blood pressure, and may cause edema, acute kidney failure, and decompensation of heart failure. Bronchospasm in aspirin-sensitive asthma, anaphylaxis, liver injury, severe skin reactions, and an increased cardiovascular risk are also possible. They should not be started without medical supervision in people with a peptic ulcer or gastrointestinal bleeding, severe kidney failure, decompensated heart failure, coagulation disorders, or a confirmed reaction to this class of medicines.

Clinically significant interactions occur between NSAIDs and anticoagulants, antiplatelet agents, glucocorticosteroids, certain antidepressants, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, lithium, and methotrexate. Combining NSAIDs with anticoagulants, antiplatelet agents, or systemic steroids sharply increases the risk of bleeding. Simultaneous use with a diuretic and a medicine that blocks the renin-angiotensin system may provoke acute kidney injury. During pregnancy, especially in the second half, their use requires an individual decision by a physician.

First-generation antihistamines, including chlorpheniramine and diphenhydramine, may sometimes slightly reduce sneezing and nasal discharge, but their effectiveness in infectious rhinitis is limited. They cause drowsiness, slowed responses, impaired memory and reaction speed, mucosal dryness, thickening of secretions, constipation, tachycardia, impaired accommodation, and urinary retention.

In older adults, first-generation antihistamines increase the risk of confusion, delirium, falls, fractures, and acute urinary retention. Some medicines can prolong the QT interval and provoke cardiac arrhythmias. They must not be combined with alcohol, sleeping pills, tranquilizers, opioids, or other sedatives. Driving and operating machinery while drowsy are dangerous. Caution is required in angle-closure glaucoma and prostatic hyperplasia. Second-generation antihistamines are mainly appropriate when an allergic component has been confirmed, rather than as standard treatment for viral rhinitis.

Intranasal glucocorticosteroids have not demonstrated convincing effectiveness for the common cold and should not routinely be prescribed for short-term catarrhal rhinitis. They may be justified in concomitant allergic rhinitis or in certain forms of prolonged rhinosinusitis. Dryness, burning, irritation, crusting, and nosebleeds may occur. Directing the spray toward the nasal septum increases the risk of chronic injury, ulceration, and, rarely, perforation.

Prolonged use of intranasal steroids may suppress local immune defense, mask a bacterial or fungal infection, and delay healing of damaged mucosa. At high doses, with prolonged treatment, when several hormonal medicines are used, or when they are combined with potent CYP3A4 inhibitors, adrenal suppression, hypercortisolism, slowed growth in children, increased intraocular pressure, glaucoma, and cataracts may occur.

Antibiotics are not used for uncomplicated acute catarrhal rhinitis because they do not act against viruses. Yellow or green nasal mucus alone does not confirm a bacterial infection. Antibacterial treatment is considered when bacterial rhinosinusitis, otitis media, pneumonia, or another complication has been confirmed or is clinically likely. Findings suggesting a bacterial process include symptoms lasting more than ten days without improvement, pronounced unilateral pain, high fever, purulent discharge, and renewed deterioration after initial improvement.

Amoxicillin and amoxicillin with clavulanate may cause nausea, diarrhea, candidiasis, rash, anaphylaxis, antibiotic-associated colitis, interstitial nephritis, and hematopoietic disorders. Clavulanic acid increases the risk of cholestatic hepatitis and liver failure. These medicines are contraindicated in severe immediate allergy to β-lactam antibiotics, while amoxicillin with clavulanate is contraindicated in patients who previously developed cholestatic liver injury while taking this combination.

Doxycycline may cause nausea, esophagitis, esophageal ulceration, phototoxic reactions, candidiasis, and drug-induced liver injury. It should not be taken immediately before bedtime or without sufficient water. Iron, calcium, magnesium, and zinc preparations and antacids reduce its absorption. Doxycycline is generally not prescribed during pregnancy or to young children.

Macrolides may cause toxic liver injury, QT interval prolongation, ventricular arrhythmia, syncope, and sudden cardiac death. Clarithromycin has numerous interactions with statins, anticoagulants, antiarrhythmic medicines, calcium channel blockers, and immunosuppressants. Unjustified antibiotic use disrupts the microbiota, promotes candidiasis, increases the risk of Clostridioides difficile infection and severe allergic reactions, and contributes to the development of resistant bacteria.

No reliable single percentage has been established for complete recovery and the absence of recurrent episodes over two years with symptomatic treatment of acute catarrhal rhinitis. Simultaneous use of vasoconstrictor medicines, pseudoephedrine, phenylephrine, antihistamines, NSAIDs, paracetamol, intranasal hormonal medicines, and unjustified antibiotics creates a cumulative burden on the nasal mucosa, liver, kidneys, gastrointestinal tract, cardiovascular system, nervous system, and immune system. Such treatment may cause rhinitis medicamentosa, bleeding, liver and kidney failure, arrhythmia, urinary retention, cognitive impairment, fungal superinfection, and drug resistance. Alternative integrative programs based on rationally selected herbal formulations can target inflammation, swelling, secretion, and mucosal recovery and generally do not exert such aggressive local and systemic effects as prolonged or unjustified combination use of chemically synthesized medicines.

Why the article does not specify dosages and duration of treatment: acute catarrhal rhinitis may differ between individuals in its cause, stage, and severity, may be accompanied by fever, cough, headache, or complications, and may occur together with chronic diseases. To select the dosage and duration of treatment, a specialist must consider the patient’s age, body weight, duration of symptoms, condition of the nasal mucosa, liver, kidneys, cardiovascular and other systems, pregnancy and lactation, as well as all medicines being taken and possible interactions. A universal regimen may be insufficient or excessive and unsafe. Therefore, this article describes treatment approaches but does not replace an individualized clinical and pharmacological assessment. A brief question may be asked in the comments to the article, while a complex clinical case can be discussed during a consultation with a clinical pharmacologist specializing in integrative medicine.