Can you write a SOAP note for a 30-year-old adult presenting with sore throat, headache, and fatigue for 24 hours, who works in a daycare where children have coughs and rhinorrhea, and who has negative rapid tests for COVID‑19, influenza, and streptococcal pharyngitis?

SOAP Note for 30-Year-Old with Acute Pharyngitis

Subjective

• Chief Complaint: Sore throat, headache, and fatigue for 24 hours
• History of Present Illness: 30-year-old adult presents with acute onset sore throat, headache, and fatigue beginning yesterday. Works in daycare setting with current exposure to children with upper respiratory symptoms (cough, rhinorrhea). Denies fever, tonsillar exudate, or cervical lymphadenopathy (if these were present, they would be documented here).
• Testing Completed: Negative rapid tests for COVID-19, influenza, and group A Streptococcus
• Pertinent Negatives: No cough (absence of cough increases suspicion for bacterial pharyngitis, though strep test already negative), no difficulty swallowing, no rash, no recent travel

Objective

• Vital Signs: [Document temperature, heart rate, blood pressure, respiratory rate, oxygen saturation]
• Physical Examination:
  • General: Alert, appears mildly fatigued but not toxic
  • HEENT: Pharyngeal erythema without exudate, tonsils [normal/enlarged without exudate], no anterior cervical lymphadenopathy
  • Neck: Supple, no meningismus
  • Lungs: Clear to auscultation bilaterally
  • Other systems as examined

Assessment

Acute viral pharyngitis (likely viral upper respiratory infection given daycare exposure, negative strep/COVID/flu testing, and symptom constellation)

Clinical Reasoning: This patient has acute pharyngitis with negative testing for the three most common treatable/reportable causes. Given the negative strep test, antibiotics are not indicated 1, 2. The 2016 ACP/CDC guidelines explicitly state that clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1. The 2012 ESCMID guidelines similarly recommend against antibiotics in patients with negative testing 2. The daycare exposure to children with respiratory symptoms strongly suggests a viral etiology, which accounts for the majority of pharyngitis cases in adults 1.

Plan

Symptomatic Management (No Antibiotics Indicated)

Analgesic therapy is the cornerstone of treatment for viral pharyngitis 1:

• Ibuprofen 400-600 mg PO every 6-8 hours as needed for pain and inflammation, OR
• Acetaminophen 650-1000 mg PO every 6 hours as needed for pain
• Throat lozenges as needed for symptomatic relief
• Consider salt water gargles (though limited evidence) 1

Patient Education

• Reassure that typical course is less than 1 week 1
• Antibiotics are not needed because testing confirmed no bacterial infection; antibiotics do little to alleviate viral symptoms and may cause adverse effects 1
• Adequate hydration and rest
• Infection control: Hand hygiene, avoid sharing utensils, stay home if febrile

Return Precautions

• Return or call if symptoms worsen or persist beyond 7 days
• Seek immediate care for: high fever (>38.5°C), difficulty breathing, difficulty swallowing/drooling, severe worsening of throat pain, or signs of dehydration
• Remain vigilant for Lemierre syndrome (rare but life-threatening) if severe pharyngitis develops, particularly given patient age (young adult) 1

Follow-Up

• No routine follow-up needed unless symptoms persist or worsen
• May return to work when feeling well enough, using standard respiratory hygiene precautions

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Clinical Pitfall to Avoid: More than 60% of adults with sore throat receive unnecessary antibiotic prescriptions despite most cases being viral 1. This patient's negative strep test definitively rules out the primary bacterial indication for antibiotics. The modest benefit of antibiotics even in confirmed strep (shortening symptoms by 1-2 days, NNT=6 at 3 days) 1 does not apply here, and prescribing would only contribute to antimicrobial resistance and potential adverse effects without benefit.