Counsel patients to effectively navigate the OTC aisle

Focus on effective symptom management options. Honey can help soothe sore throats and coughs.² Sterile saline nasal washes can help relieve congestion.³

Talk to older patients about which medications should be avoided, such as 1^st generation antihistamines, like diphenhydramine and doxylamine, as well as phenylephrine, which is ineffective and potentially harmful.⁴

Read the labels on any combination products. These may contain acetaminophen or ibuprofen. Ensure patients know daily dose limits if taking other prescriptions with these medications. Many combination products contain phenylephrine or 1^st generation antihistamines that should be avoided in older adults as well.

Use testing when it changes management

Antigen or rapid tests are available OTC for influenza and COVID-19. A positive result of either test gives reasonable confidence of infection. For these viral illnesses, identification of the causative pathogen only matters if it changes treatment.

Prescribe appropriate treatment when needed

• Antiviral treatment for influenza and COVID-19 is recommended for patients at high risk for severe disease, like adults age 65 or over, with chronic conditions or immunocompromise.
• Antibiotics are not needed for bronchitis or acute sinusitis lasting < 10 days, as these are typically viral infections.
• Know antibiotic resistance rates. In many parts of the country azithromycin is ineffective against Streptococcus pneumoniae, a common cause of bacterial sinusitis and community-acquired pneumonia.⁵
• Prevent infection through vaccination and handwashing.

Information current at time of publication, August 2025.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

• National Ambulatory Medical Care Survey. 2022 NAMCS Questionnaires, Datasets and Documentation. https://www.cdc.gov/nchs/namcs/documentation/ about-the-data-2019.html. Accessed June 9, 2025.
• Abuelgasim H, et al. BMJ Evid Based Med. 2021;26(2):57-64.
• King D, et al. Cochrane Database Syst Rev. 2015;2015(4):Cd006821.
• Hatton RC, et al. Ann Pharmacother. 2007 Mar;41(3):381-90.
• Gupta V, et al. Open Forum Infect Dis. 2021;8(7):ofab063.