Respiratory Infections

The onset of winter in the Washington, DC, Northern Virginia, and Maryland metropolitan area brings with it an increase in the frequency of respiratory infections. In comparison to individuals without an underlying long-term health condition, people with a history of allergies, asthma, diabetes, as well as individuals with suppressed immune systems are more susceptible to respiratory tract infections.

Some common respiratory infections during the Winter include:

Sinus infections (acute rhinosinusitis):
According to Centers for Disease Control and Prevention, about 1 in 8 adults are diagnosed with sinus infections yearly, resulting in more than 30 million diagnoses in the U.S. More than 90% of these cases are viral. Antibiotics are not guaranteed to be of any benefit, even when they are caused by bacteria.

Bacterial cause is more likely when the symptoms are:

  1. Severe, such as fever of more than 102°F and discolored nasal secretions or facial pain lasting for more than 3 to 4 days.
  2. Persistent nasal discharge or daytime cough lasting longer than 10 days.
  3. Worsening fever, cough, or nasal discharge after initial improvement of a viral upper respiratory infection lasting for 5 to 6 days.
  4. Sinus X-rays and CT scans are not routinely recommended.


  1. Watchful waiting is appropriate for uncomplicated cases.
  2. Amoxicillin or Augmentin is the preferred first-line antibiotic choice.
  3. The macrolide class of antibiotics [(e.g., azithromycin (Z-Pak)] is not recommended as up to 40% of the bacteria causing sinus infections are not sensitive to them.
  4. For patients are who are allergic to penicillin, doxycycline or the quinolone class of antibiotics are suitable alternatives.


Inflammation of the lining of the bronchial tubes that carry air in and out of the lungs causes a cough lasting several days or weeks.

  1. Fever of more than 102°F, rapid heart-beat, rapid breathing, and abnormal lung examination findings may suggest pneumonia.
  2. Discolored sputum does not always indicate bacterial infection.
  3. Chest X-rays are not needed in most instances.

Medications for relief of symptoms may include:

  1. Cough suppressants (e.g., codeine, dextromethorphan)
  2. First generation antihistamines (e.g., diphenhydramine)
  3. Decongestants (e.g., pseudoephedrine, phenylephrine)
  4. Bronchodilators (e.g., albuterol)

Non-specific upper respiratory tract infections (URI’s):

Most adults experience two to four URI’s (e.g., “colds”) each year. More than 200 different types of viruses are known to cause the common cold.

Prominent “cold” symptoms consist of nasal congestion, clear runny nose, post-nasal drip, sore throat, cough, fever, headache, and/or body aches.

Treatment is mostly geared towards relieving symptoms, as the condition usually resolves spontaneously after a few days to one week and antibiotics are not needed.

Decongestants combined with first-generation antihistamines may provide short-term relief of nasal symptoms and cough. Anti-inflammatory medications (e.g., ibuprofen, naproxen) can relieve fever and aches. Nasal saline irrigation can sometimes be helpful.

Pharyngitis (throat inflammation):

About 90% of throat infections are caused by viruses. Only about 5 to 10% of cases are due to bacteria which are commonly referred to as “Strep throat.”

Rapid Antigen Detection Test (RADT), also known as a “strep-test” may be necessary to distinguish between viral and bacterial pharyngitis, as the clinical features are similar in both conditions.

Antibiotics are not recommended for patients with a negative RADT result. For those with a positive RADT result, amoxicillin or penicillin VK are the drugs of choice as they are very effective against streptococcal bacteria. For penicillin-allergic patients, antibiotics in the macrolide class, as well as clindamycin, may be utilized. The duration of treatment for bacterial pharyngitis is typically 10 days.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metro area and are very experienced in managing various respiratory infections. They are experts in checking the immune systems in individuals that develop frequent and/or unusual infections, since they are also immunologists. Black & Kletz treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to make an appointment. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, DC, Northern Virginia, and Maryland metro area for more than a half a century and pride ourselves in providing excellent quality allergy, immunology, and asthma care in a professional and friendly setting.