Management of Fever (38°C), Dry Cough, and Sore Throat
This presentation is most consistent with a viral upper respiratory tract infection that requires symptomatic treatment only—antibiotics are not indicated unless specific criteria for bacterial pharyngitis are met. 1, 2, 3
Immediate Assessment: Rule Out Bacterial Pharyngitis
The presence of cough actually argues against bacterial pharyngitis and strongly suggests a viral etiology. 1 Apply the modified Centor criteria to determine if testing for Group A Streptococcus is warranted: 1
- Fever by history
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Absence of cough (your patient has cough, which counts against bacterial infection)
If fewer than 3 Centor criteria are met, do not test and do not prescribe antibiotics. 1 Since your patient has a dry cough, this alone significantly reduces the likelihood of streptococcal pharyngitis and makes viral infection far more probable. 1, 3
Recommended Management: Symptomatic Treatment
Provide symptomatic relief regardless of the underlying cause: 1, 2
- Antipyretics for fever control: Ibuprofen or acetaminophen (paracetamol) 2, 4
- Analgesics for throat pain 1, 3
- Throat lozenges 1
- First-generation antihistamines 1
- Decongestants 1
- Adequate fluid intake to maintain hydration 2
- Rest to reduce metabolic demands 2
Avoid cough suppressants like dextromethorphan in the absence of clear indication, as efficacy is unproven and risks exist. 2, 5
Expected Clinical Course and Safety-Netting
Reassure the patient that typical sore throat resolves in less than 1 week, and acute bronchitis is self-limited. 1 Fever typically settles in 2-4 days, though cough may persist 1-2 weeks. 2
Monitor for red flags that require immediate re-evaluation: 2, 3
- Fever persisting >4-5 days without improvement 2, 3
- Development of respiratory distress (tachypnea, retractions, hypoxia) 2, 3
- Altered consciousness or drowsiness 2
- Severe dehydration or inability to take oral fluids 2
- Cyanosis 2
When to Consider Antibiotics
Only prescribe antibiotics if Group A Streptococcus is confirmed by rapid antigen detection test or throat culture. 1 If testing is positive, use penicillin (oral for 10 days) or amoxicillin as first-line treatment. 1 For penicillin allergy, use first-generation cephalosporins or macrolides. 1
If pneumonia is suspected based on abnormal lung auscultation, respiratory distress, or persistent high fever, obtain a chest X-ray before initiating antibiotics. 3 If pneumonia is confirmed, prescribe a minimum of 5 days of antibiotics. 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics for viral bronchitis—they cause more harm than benefit and contribute to antibiotic resistance. 3
- Do not rely on fever duration alone to diagnose bacterial infection; 5 days of fever warrants evaluation but does not automatically indicate bacterial etiology. 3
- Do not use antibiotics prophylactically to prevent complications in low-risk patients. 2
- Never use aspirin in children under 16 years due to Reye syndrome risk. 2