What is the diagnosis and recommended treatment for a 5-year-old female patient presenting with nasal congestion, cough, sore throat, and loss of appetite for 6 days?

Medical Assessment and Treatment Plan

Diagnosis: Acute Viral Upper Respiratory Tract Infection (Common Cold)

This 5-year-old presents with a typical viral URI that does not require antibiotics. The 6-day duration of productive cough, rhinorrhea, sore throat, and loss of appetite without fever or worsening symptoms is consistent with an uncomplicated viral infection 1, 2.

Clinical Reasoning

Why This is NOT Bacterial Sinusitis

• Symptoms have not persisted beyond 10 days without improvement - the key diagnostic criterion for bacterial sinusitis requires symptoms lasting more than 10 days, and this patient is only at day 6 1
• No "worsening course" - bacterial sinusitis is diagnosed when there is worsening or new onset of symptoms after initial improvement, which is not present here 1
• No "severe onset" - would require fever ≥39°C with purulent nasal discharge for at least 3 consecutive days, which this patient lacks 1
• The productive cough and nasal discharge are entirely consistent with normal viral URI progression, where cough and rhinorrhea commonly persist into the second week 1

Why Antibiotics Are NOT Indicated

• Viral URIs account for 98% of acute infectious rhinitis in children and resolve spontaneously 1
• Antibiotics should not be prescribed for common cold, nonspecific URI, or acute cough illness 1
• The American Academy of Pediatrics explicitly states that management should focus on symptomatic relief only 1

Treatment Plan

Supportive Care Only

• Nasal saline irrigation for congestion relief 3
• Adequate hydration and rest
• Antipyretics if fever develops (paracetamol 10-15 mg/kg/dose every 4-6 hours as needed)
• No cough and cold medications - OTC cough and cold preparations should be avoided in children below 6 years of age due to lack of efficacy and potential toxicity 1

Watchful Waiting with Return Precautions

Return immediately if:

• Symptoms persist beyond 10 days without improvement 1
• Worsening symptoms after initial improvement 1
• High fever ≥39°C develops with purulent discharge 1
• Difficulty breathing or respiratory distress 4

Expected Course

• Symptoms typically resolve within 6.6 to 8.9 days in this age group 1
• Cough and nasal drainage may persist up to 2 weeks, which is normal for viral infections 1

Medications Prescribed

NONE - No medications indicated or prescribed

Total cost: ₱0 (well within ₱300 budget)

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Medical Certificate

DIAGNOSIS: Acute Viral Upper Respiratory Tract Infection (Common Cold)

RECOMMENDATION:

• Supportive care with adequate rest and hydration
• May return to school when feeling well enough to participate in activities
• Fit to return to school - no isolation required for uncomplicated viral URI
• Follow up if symptoms persist beyond 10 days or worsen

PURPOSE: Return to school after illness

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Key Clinical Pearls

• Do not prescribe antibiotics based on duration alone - the 10-day threshold is for persistent symptoms WITHOUT improvement, not just any symptoms lasting 10 days 1
• Mucopurulent discharge is normal in viral URIs after a few days due to neutrophil influx and does not indicate bacterial infection 1
• Avoid the antibiotic prescribing trap - inappropriate antibiotic use for viral URIs enhances parent belief in their effectiveness and increases future consultations for minor illnesses 5