What should I do if I have had intermittent fever, coughing, and chest pain due to coughing for 4 days?

Management of Intermittent Fever, Cough, and Chest Pain for 4 Days

You most likely have acute bronchitis, which is a viral infection that does not require antibiotics, and should be managed with symptomatic treatment and reassurance that symptoms typically resolve within 10-14 days. 1

Immediate Assessment Required

You need to determine if this is simple acute bronchitis versus pneumonia, which requires different management:

Check for pneumonia warning signs - You should seek immediate medical evaluation if you have any of the following 2, 1:

• Heart rate >100 beats/min (tachycardia)
• Breathing rate >24 breaths/min (tachypnea)
• Oral temperature >38°C (100.4°F)
• Abnormal lung sounds on chest examination (rales, crackling sounds, or abnormal vibrations when speaking)

If pneumonia signs are present, you need a chest X-ray to confirm the diagnosis 2. The combination of acute cough plus any one of these findings—new focal chest signs, shortness of breath, rapid breathing, or fever lasting >4 days—should raise suspicion for pneumonia 2.

Most Likely Diagnosis: Acute Bronchitis

Since you describe intermittent (not persistent high) fever with cough and chest pain only from coughing for 4 days, this presentation is most consistent with acute bronchitis 1.

Key facts about acute bronchitis 1:

• Caused by respiratory viruses in 89-95% of cases
• Cough with or without phlegm production lasting up to 3 weeks
• Chest pain is typically due to the mechanical irritation from coughing itself

What NOT to Do

Do not take antibiotics - Antibiotics provide minimal benefit (reducing cough by only about half a day) while exposing you to adverse effects and contributing to antibiotic resistance 1. This applies even if you have colored or purulent sputum, as sputum color does not indicate bacterial infection 1.

Do not use routine bronchodilators - β2-agonist inhalers should not be routinely used unless you have wheezing accompanying your cough 1.

Recommended Treatment Approach

For symptomatic relief 1, 3:

• Honey and lemon - This is the simplest and most cost-effective home remedy
• Dextromethorphan 60 mg - This is the preferred cough suppressant for maximum cough reflex suppression
• First-generation antihistamines - May help specifically for nighttime cough that disturbs sleep
• Menthol inhalation - Can provide short-term cough suppression

For chest pain from coughing 3:

• The pain is mechanical from the coughing itself and will resolve as the cough improves
• Over-the-counter pain relievers can help, though NSAIDs at anti-inflammatory doses are not recommended for bronchitis treatment 1

Expected Timeline and Follow-Up

Normal duration - Your cough will typically last 10-14 days from now, which is the expected course for viral bronchitis 1, 3.

When to seek re-evaluation 3:

• If cough persists beyond 3 weeks (becomes subacute cough requiring reassessment)
• If cough persists beyond 8 weeks (requires comprehensive evaluation for chronic causes)
• If you develop danger signs: coughing up blood, significant breathlessness, fever ≥38°C that persists, or worsening symptoms suggesting bacterial superinfection 1, 3

Special Exception: Pertussis (Whooping Cough)

If you have severe coughing paroxysms (uncontrollable coughing fits) or a characteristic "whoop" sound when breathing in after coughing, you may have pertussis, which does require antibiotic treatment with a macrolide like erythromycin 1. This would also require isolation for 5 days from the start of treatment 1.

Common Pitfall to Avoid

The intermittent nature of your fever does not make bacterial infection more likely - viral infections commonly cause intermittent fevers 4. The key is assessing for pneumonia signs rather than the fever pattern itself.