Diagnosis and Management for 18-Year-Old Male with Fever, Productive Cough, and Yellow-Green Sputum
This patient has acute bronchitis and should NOT receive antibiotics. The yellow-green sputum does not indicate bacterial infection, and routine antibiotic treatment is not justified for acute bronchitis. 1, 2, 3
Medical Assessment/Diagnosis
Diagnosis: Acute Bronchitis (Acute Lower Respiratory Tract Infection)
Clinical Reasoning:
- Cough duration of 10 days with fever 38.0°C and purulent sputum is consistent with acute bronchitis (cough <3 weeks duration). 1, 2
- Pneumonia is ruled out because the patient lacks: tachycardia (>100 bpm), tachypnea (>24 breaths/min), high fever (>38°C oral), and abnormal chest examination findings (rales, egophony, tactile fremitus). 1, 2
- Normal UA and WBC 10.30 (within normal range) further support viral etiology without bacterial superinfection. 2
- Yellow-green sputum color does NOT indicate bacterial infection - purulence is due to inflammatory cells or sloughed mucosal epithelial cells, not bacteria. 1, 3
- More than 90% of acute bronchitis cases in otherwise healthy patients are viral. 1, 4
Treatment Plan/Recommendations
NO Antibiotics Indicated:
- Antibiotics are NOT recommended for acute bronchitis without evidence of pneumonia. 1, 2
- Routine antibiotic treatment should not be offered for acute bronchitis. 1
- Sputum color alone is not a reliable indicator for antibiotic prescription. 3
Symptomatic Management (Within 300 Pesos Budget):
For cough suppression (if bothersome productive cough):
- Dextromethorphan 15 mg every 6-8 hours as needed
- Dispense: 20 tablets
- Duration: 5-7 days
- Cost: ~150-200 pesos 2
Supportive care instructions:
- Adequate hydration
- Rest
- Antipyretics for fever (paracetamol 500mg every 6 hours as needed)
Critical Red Flags - Return Immediately If:
- Fever persists >4 days 2
- Development of dyspnea or difficulty breathing 1, 2
- Worsening symptoms or clinical deterioration 2
- New chest pain or hemoptysis 1
Follow-up Plan:
- Routine follow-up in 4-6 weeks if symptoms persist to reassess for subacute cough causes (post-infectious cough, upper airway cough syndrome, or bronchial hyperreactivity). 1, 2
- Expected symptom duration: typically 3 weeks. 1, 4
Medical Certificate
This certifies that patient has been seen and examined today with the diagnosis of: Acute Bronchitis (Acute Lower Respiratory Tract Infection)
And recommendation of: Symptomatic treatment with cough suppressant and supportive care. Rest for 3-5 days. May return to work/school when fever-free for 24 hours and symptoms improving.
This medical certificate is issued upon the request of the patient for: Return to work/school (patient took leave due to illness)
Important Clinical Pitfalls to Avoid:
- Do not prescribe antibiotics based on sputum color alone - this is the most common error in acute bronchitis management. 1, 3
- Do not prescribe expectorants, mucolíticos, antihistamines, or bronchodilators - these have no proven benefit in acute bronchitis. 2
- Do not order chest X-ray unless pneumonia is clinically suspected based on vital signs and examination findings. 1
- Antibiotics would only be indicated if patient develops confirmed pneumonia, fever >4 days, or clinical deterioration with respiratory distress. 2