What is the recommended treatment for a 39-year-old male presenting with symptoms of nasal congestion, sore throat, cough, and severe laryngitis, with a temperature of 100.1 degrees Fahrenheit and a red pharynx, during influenza season?

From the Guidelines

For this patient with symptoms consistent with viral upper respiratory infection, I recommend supportive care including rest, adequate hydration, and over-the-counter medications for symptom relief. Specifically, the patient can take acetaminophen (Tylenol) 650 mg every 6 hours as needed for fever and discomfort, or ibuprofen (Advil, Motrin) 400-600 mg every 6-8 hours with food. For his laryngitis, which is his primary concern given his upcoming speaking engagement, warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily and voice rest are essential. Throat lozenges containing benzocaine or menthol may provide temporary relief. Humidification of his environment, especially at night, can also help soothe his irritated throat tissues.

Key Considerations

• Antibiotics are not recommended as his presentation is consistent with a viral infection, likely influenza or another respiratory virus, as stated in the clinical practice guideline: hoarseness (dysphonia) (update) 1.
• The duration of symptoms (3-5 days) and low-grade fever are typical of viral illness, and antibiotics would not speed recovery or prevent complications in this otherwise healthy adult.
• His symptoms should improve within 7-10 days with these measures, potentially allowing him to recover before his conference.

Additional Recommendations

• The patient should be advised to stay hydrated by drinking plenty of fluids, such as water, tea, or soup.
• Over-the-counter medications such as cough suppressants (dextromethorphan) or expectorants (guaifenesin) may be used to relieve cough symptoms, as suggested by the appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the american college of physicians and the centers for disease control and prevention 1.
• The patient should avoid smoking and secondhand smoke, which can irritate the throat and worsen symptoms.
• If the patient's symptoms worsen or do not improve within 7-10 days, further evaluation and treatment may be necessary, as indicated by the pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic 1.

From the FDA Drug Label

In two randomized, placebo-controlled, double-blind clinical trials of oseltamivir phosphate were conducted in adults between 18 and 65 years old, one in the U.S. and one outside the U.S., for the treatment of acute uncomplicated influenza. Eligible subjects had fever of at least 100ºF, accompanied by at least one respiratory symptom (cough, nasal symptoms, or sore throat) and at least one systemic symptom (myalgia, chills/sweats, malaise, fatigue, or headache), and influenza virus was known to be circulating in the community In both trials, there was a 1. 3-day reduction in the median time to improvement in influenza-infected subjects who received oseltamivir phosphate 75 mg twice a day for 5 days compared to subjects who received placebo.

The patient is a 39-year-old male presenting with symptoms of influenza, including nasal congestion, sore throat, and cough, and is concerned about a planned conference. Oseltamivir phosphate may be recommended for this patient’s condition, as it has been shown to reduce the median time to improvement in influenza-infected adults by 1.3 days compared to placebo 2. The recommended dose is 75 mg twice daily for 5 days.

From the Research

Treatment Options for Acute Laryngitis

• The patient presents with symptoms of acute laryngitis, including severe laryngitis, nasal congestion, sore throat, and cough 3, 4, 5.
• The evidence suggests that antibiotics are not effective in treating acute laryngitis, as they do not improve objective outcomes such as voice scores 3, 4, 5.
• However, some studies suggest that antibiotics like erythromycin may reduce subjective symptoms such as voice disturbance and cough at one and two weeks, respectively 3, 4, 5.
• Other treatment options for acute laryngitis may include palliation and symptomatic relief, such as discussing the causes of symptoms, maximizing distraction, and focusing attention away from the body 6.
• For pain management, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment options for mild to moderate pain 7.

Recommendations for the Patient

• Based on the evidence, it is recommended that the patient does not receive antibiotics as a first-line treatment for acute laryngitis 3, 4, 5.
• Instead, the patient may benefit from palliation and symptomatic relief, such as rest, hydration, and pain management with acetaminophen or NSAIDs 6, 7.
• The patient should be monitored for any changes in symptoms or worsening of condition, and further treatment should be tailored to their individual needs 3, 4, 5.