What is the diagnosis and recommended treatment for a 1-year-old male patient presenting with a 1-week history of cold symptoms, a 5-day history of cough, and phlegm production, without fever?

Diagnosis: Acute Viral Upper Respiratory Tract Infection (Acute Bronchitis)

This 1-year-old male has acute viral bronchitis, which requires only supportive care without antibiotics, as the infection is self-limited and viral in origin. 1

Clinical Assessment

The presentation of 1 week of rhinorrhea, 5 days of cough with phlegm production, and absence of fever is classic for an uncomplicated viral upper respiratory infection manifesting as acute bronchitis. 1 The American College of Chest Physicians confirms that acute bronchitis should be diagnosed when cough with or without sputum production lasts up to 3 weeks, provided pneumonia has been ruled out clinically. 2

No chest X-ray is needed since this child lacks clinical features suggesting pneumonia (no fever >4 days, no dyspnea/tachypnea, no focal chest findings). 1

Treatment Plan

Antibiotics are NOT indicated and should NOT be prescribed, as routine antibiotic treatment for acute bronchitis is not justified—the infection is viral, not bacterial. 2, 1

Symptomatic Management (PhilHealth Konsulta-Compatible):

• Supportive care only: Rest, adequate hydration, and reassurance that symptoms will resolve within 3 weeks 1

• Paracetamol (Acetaminophen): 10-15 mg/kg/dose every 4-6 hours as needed for discomfort

  • Dispense: 120mg/5mL suspension, 60mL bottle
  • Duration: As needed for symptom relief
  • Cost: ~₱50-80 per bottle 3

• Saline nasal drops: For nasal congestion relief (non-pharmacologic, minimal cost)

Total medication cost: <₱100 (well within ₱300 budget)

Medical Certificate

Diagnosis: Acute Viral Upper Respiratory Tract Infection (Acute Bronchitis)

Recommendation: Supportive care with adequate rest and hydration. Patient may return to daycare/usual activities as tolerated. Condition is self-limited and expected to resolve within 2-3 weeks. No antibiotics required. Return for reassessment if fever develops, symptoms worsen, or cough persists beyond 3 weeks.

Fit for: Return to usual activities as tolerated (viral illness is contagious but not requiring isolation)

Critical Follow-Up Thresholds

• If cough persists 3-8 weeks: Consider post-infectious cough; may trial inhaled ipratropium if available 4
• If cough persists >8 weeks: Reclassify as chronic cough and evaluate for other etiologies (upper airway cough syndrome, asthma) 1, 5
• Return immediately if: High fever develops (>39°C), difficulty breathing, inability to feed, or clinical deterioration 2

Common Pitfalls to Avoid

Do not prescribe antibiotics based on colored nasal discharge or productive cough—these are typical viral features and do not indicate bacterial infection. 2, 1 The American College of Chest Physicians explicitly states that colored sputum is NOT an indication for antibiotics in acute bronchitis. 2

Do not use cough suppressants in young children under 2 years of age, as dextromethorphan is not recommended in this age group per FDA labeling. 6