Management of Sore Throat, Chills, and Runny Nose
This presentation is most consistent with a viral upper respiratory infection (common cold), which requires only symptomatic treatment—antibiotics should not be prescribed. 1, 2
Initial Assessment and Diagnosis
The combination of sore throat, chills, and runny nose strongly suggests a viral upper respiratory infection rather than bacterial pharyngitis. 1, 2 The presence of rhinorrhea (runny nose) is particularly important because it is uncommon in streptococcal pharyngitis and suggests a viral cause. 3, 4
Key Clinical Features to Evaluate
Look for these specific findings to distinguish viral from bacterial causes:
- Viral indicators (favor symptomatic treatment only): Runny nose, cough, conjunctivitis, sneezing, gradual onset 1, 3
- Bacterial indicators (may warrant antibiotics): Tonsillar exudates, tender anterior cervical lymphadenopathy, fever >38°C, absence of cough 5, 3
Use the Centor Criteria for Risk Stratification
Apply the modified Centor score (1 point each): 5, 3
- Fever (temperature >38°C)
- Tonsillar exudates
- Tender anterior cervical lymphadenopathy
- Absence of cough
Scoring interpretation:
- 0-2 points: Do NOT prescribe antibiotics—viral etiology most likely 5
- 3-4 points: Consider antibiotics only after discussing modest benefits versus risks 5
Recommended Treatment Approach
First-Line Symptomatic Management
For pain and fever relief:
- Ibuprofen or paracetamol (acetaminophen) are equally effective first-line options 5, 2
- NSAIDs like ibuprofen significantly improve headache, ear pain, and muscle/joint pain 2
For nasal congestion:
- Saline nasal irrigation provides relief without adverse effects 2
- Oxymetazoline nasal spray may provide modest relief for severe congestion, but limit use to 3 days maximum to avoid rebound rhinitis medicamentosa 2
What NOT to Do
Do not prescribe antibiotics for this presentation. 1, 2 The evidence is clear:
- Antibiotics provide no benefit for common cold symptoms 1, 2
- They cause significant adverse effects with number needed to harm of only 8 patients 1
- The presence of runny nose strongly suggests viral etiology where antibiotics are ineffective 3, 4
Avoid these interventions:
- Zinc gluconate—not recommended 5
- Herbal treatments—inconsistent evidence 5
- Antibacterial soap over regular soap—no additional benefit 1
Expected Clinical Course
The common cold is self-limited and typically resolves within 2 weeks without treatment. 2 Patients should expect gradual improvement over 7-10 days. 1
Red Flags Requiring Urgent Evaluation
Instruct the patient to return immediately if they develop: 6
- Severe unilateral throat swelling with uvular deviation (peritonsillar abscess)
- Drooling, stridor, or respiratory distress (epiglottitis)
- Neck stiffness or swelling (retropharyngeal abscess)
- Inability to swallow or "hot potato voice"
Also return if: 2
- Symptoms persist beyond 10 days
- Symptoms worsen after initial improvement ("double sickening")—suggests bacterial sinusitis 1
- High fever >39°C with purulent nasal discharge for ≥3 consecutive days 1
Prevention Measures
Hand hygiene is the most effective prevention strategy:
- Regular handwashing with soap and water reduces viral respiratory tract infections by up to 40% 1
- Hand sanitizer use shows modest benefit in community settings 1
- Direct hand contact is the most efficient transmission route 1
Common Pitfalls to Avoid
Do not prescribe antibiotics "just in case"—even for confirmed streptococcal pharyngitis, antibiotics provide only modest symptom relief and do not prevent suppurative complications in most cases. 5 The number needed to treat for rapid cure in acute rhinosinusitis is 18, while the number needed to harm is only 8. 1
Do not continue topical decongestants beyond 3 days—rebound congestion (rhinitis medicamentosa) will develop, requiring intranasal or systemic corticosteroids for treatment. 1, 2