What should I do about my persistent sore throat and fever that worsened after traveling to another state, despite taking anti-allergic medication and steroidal (corticosteroid) nasal spray for 2 weeks?

Persistent Upper Respiratory Symptoms After Travel: Likely Acute Bacterial Rhinosinusitis Requiring Antibiotic Consideration

You likely have acute bacterial rhinosinusitis (ABRS) based on the "double sickening" pattern—initial improvement followed by worsening after travel—and failure to respond to 2 weeks of intranasal corticosteroids and antihistamines. 1

Why This Is Bacterial, Not Just Allergic or Viral

Your symptom pattern meets diagnostic criteria for ABRS through the "double sickening" phenomenon: 1

• Initial viral cold that improved within a week (typical viral course lasts 5-10 days) 1
• Worsening symptoms after travel to another state (new fever or substantial worsening of nasal discharge/cough after initial improvement) 1
• Persistent symptoms for 2+ weeks total without improvement despite appropriate medical therapy 1

The fact that intranasal corticosteroids and antihistamines haven't worked after 2 weeks strongly argues against pure allergic rhinitis, as intranasal corticosteroids are the most effective treatment for allergic inflammation and typically show benefit within 2-4 weeks. 2

What You Need Now

Antibiotics are indicated based on your clinical pattern. 1 The American Academy of Otolaryngology-Head and Neck Surgery recommends antibiotic treatment when symptoms worsen after initial improvement (the "double sickening" pattern you experienced after traveling). 1

First-Line Antibiotic Options:

• Amoxicillin-clavulanate is the preferred first-line agent for ABRS 1
• Treatment duration: 5-10 days 1

Continue Supportive Measures:

• Nasal saline irrigation (helps maintain sinus drainage and provides symptomatic relief) 1, 3
• Continue intranasal corticosteroids (reduces inflammation even in bacterial infection) 1
• Analgesics (acetaminophen or ibuprofen for facial pain/pressure) 4

Critical Pitfall to Avoid

Do not assume this is "just allergies" because antihistamines were prescribed. 1 Colored or purulent nasal discharge does not distinguish viral from bacterial infection by itself, but when combined with your temporal pattern (worsening after improvement) and duration (>10 days), it strongly suggests bacterial infection. 1 Antihistamines are ineffective for acute bacterial sinusitis and should not be used as primary treatment. 1

When to Seek Urgent Care

Watch for warning signs of complications requiring immediate evaluation: 1

• Periorbital edema or swelling around the eyes
• Vision changes or double vision
• Severe headache or altered mental status
• High fever >39°C (102.2°F) persisting despite treatment

Expected Timeline

• Improvement should occur within 48-72 hours of starting antibiotics 4
• If symptoms worsen or fail to improve in this timeframe, reassessment is warranted 4
• Refer to an allergist/immunologist if symptoms persist beyond antibiotic treatment, as this would suggest difficult-to-treat rhinosinusitis or underlying allergic disease requiring further evaluation 2, 3

Why Travel Triggered This

Environmental exposure to new allergens or irritants during travel likely triggered an exacerbation of underlying sinonasal inflammation, creating conditions favorable for secondary bacterial infection. 2 This represents an acute exacerbation pattern rather than simple recurrence. 2