Symptomatic treatment:
Analgesia
Mechanical irrigation with buffered, hypertonic saline
OTC decongestants
Intranasal decongestants (e.g. oxymetazoline for no more than 3 days)
Intranasal corticosteroids (e.g. mometasone furoate monohydrate, Flonase)
Avoid antibiotics (Part of ACEP Choosing wisely)
Analgesia
Mechanical irrigation with buffered, hypertonic saline
OTC decongestants
Intranasal decongestants (e.g. oxymetazoline for no more than 3 days)
Intranasal corticosteroids (e.g. mometasone furoate monohydrate, Flonase)
Possible bacterial source, especially if associated with:
No clinical improvement after 10 days
Severe symptoms or high fever and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness
Onset with newly worsening that were initially improving (‘‘doublesickening’’)
Acute bacterial<unk> 
Strep pneumo, non-typeable H. flu, Moraxella
First line is amoxicillin-clavulanate for 7-10 days
Amox 40-45mg/kg PO with clavulanate 3.2 mg/kg PO bid for 10d
Second line is a respiratory fluoroquinolones (moxifloxacin, gemifloxacin, and levofloxacin) or doxycycline
If allergic, can use cefdinir (7mg/kg PO bid) or cefuroxime (15 mg/kg PO bid)
No clinical improvement after 10 days
Severe symptoms or high fever and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness
Onset with newly worsening that were initially improving (‘‘doublesickening’’)
Strep pneumo, non-typeable H. flu, Moraxella
First line is amoxicillin-clavulanate for 7-10 days
Amox 40-45mg/kg PO with clavulanate 3.2 mg/kg PO bid for 10d
Second line is a respiratory fluoroquinolones (moxifloxacin, gemifloxacin, and levofloxacin) or doxycycline
If allergic, can use cefdinir (7mg/kg PO bid) or cefuroxime (15 mg/kg PO bid)
Amox 40-45mg/kg PO with clavulanate 3.2 mg/kg PO bid for 10d
Obtain culture
Consider nosocomial bacterial<unk>  (e.g. after prolonged nasotracheal intubation)
Consider foreign body
Consider antifungals
Sinusitis
Upper respiratory infection, influenza
Laryngitis
Mastoiditis
Juvenile nasopharyngeal angiofibroma
Croup
Nasal polyp
Pharyngitis