What treatment and precautions should I take for a sore throat, nasal congestion, green phlegm, lethargy, and hyperthermia (fever), and can I safely return to midwife duties without infecting others?

Management of Upper Respiratory Tract Infection in a Healthcare Worker

You should not return to midwife duties until you have been fever-free for 24 hours without fever-reducing medications and your symptoms have substantially improved, as you are currently infectious and pose a significant risk to vulnerable newborns and postpartum mothers. 1

Immediate Clinical Assessment

Your presentation of sore throat, nasal congestion, green phlegm, fever (38°C), and lethargy for several days is consistent with an acute upper respiratory tract infection (URTI), most likely viral in nature. 2 However, given your healthcare role with high-risk patients (newborns and postpartum mothers), specific considerations apply:

Key Diagnostic Considerations

• Group A Streptococcus (GAS) must be ruled out given your severe sore throat and healthcare worker status in a maternity setting, as GAS can cause serious invasive infections in postpartum mothers and neonates. 1
• A throat swab for bacterial culture should be obtained to identify potential GAS pharyngitis, which requires specific antibiotic treatment and work exclusion protocols. 1
• Green phlegm alone does not indicate bacterial infection requiring antibiotics, as colored sputum commonly occurs with viral URTIs. 2

Treatment Recommendations

Symptomatic Management (Primary Treatment)

• Paracetamol (acetaminophen) 500-1000 mg every 4-6 hours as needed (maximum 4000 mg/24 hours) for fever and sore throat pain. 3, 2
• Nasal decongestants (such as pseudoephedrine or oxymetazoline nasal spray) provide proven effectiveness for nasal congestion in adults. 2
• Zinc supplementation has proven effectiveness for reducing cold symptom duration in adults. 2
• Adequate hydration and rest are essential supportive measures. 2

When Antibiotics ARE Indicated

Antibiotics should NOT be prescribed for uncomplicated viral URTI as they provide no benefit and increase antibiotic resistance risk. 2, 4 However, antibiotics are indicated if:

• GAS pharyngitis is confirmed by throat culture: Treat with amoxicillin 500 mg three times daily for 10 days, or penicillin V 500 mg four times daily for 10 days. 1, 5
• Bacterial lower respiratory tract infection is documented with both bacterial pathogen isolation AND viral co-infection, where amoxicillin may reduce illness deterioration risk. 4

Work Exclusion Guidelines for Healthcare Workers

Mandatory Exclusion Criteria

• You must be excluded from all clinical duties until 24 hours after starting appropriate antibiotic treatment AND resolution of symptoms if GAS infection is confirmed. 1
• You must remain off work while febrile (temperature >37.5°C) and symptomatic with respiratory secretions, as you pose direct transmission risk to vulnerable patients. 1
• Healthcare workers with symptoms of possible GAS infection must inform their line manager and occupational health immediately for risk assessment. 1

Safe Return-to-Work Criteria

• Fever-free for at least 24 hours without antipyretics (fever-reducing medications). 1
• Substantial improvement in respiratory symptoms, particularly reduction in cough and nasal secretions. 1
• If GAS confirmed: completion of 24 hours of appropriate antibiotic therapy before returning to patient care. 1

Infection Control Precautions

While Symptomatic (Before Returning to Work)

• Practice meticulous hand hygiene with soap and water or alcohol-based hand rub after coughing, sneezing, or touching respiratory secretions. 1
• Avoid close contact with others, particularly pregnant women, newborns, and immunocompromised individuals. 1
• Cover coughs and sneezes with tissue or elbow, disposing of tissues immediately. 1

Upon Return to Clinical Duties

• Perform hand hygiene before and after every patient contact, and immediately after touching respiratory secretions or contaminated objects. 1
• Wear appropriate personal protective equipment (PPE) including gloves when potential exists for contacting mucous membranes or body fluids, and surgical masks during procedures likely to generate respiratory secretions. 1
• Change gloves between each patient and wash hands immediately after glove removal to prevent microorganism transfer. 1

Critical Pitfalls to Avoid

• Do not return to work while still febrile or with significant respiratory symptoms, even if you feel pressure to return—the risk to vulnerable neonates and postpartum mothers is substantial. 1
• Do not self-prescribe antibiotics without confirmed bacterial infection, as this promotes resistance and provides no clinical benefit for viral URTI. 2, 4
• Do not assume green phlegm means bacterial infection requiring antibiotics—this is a common misconception, as viral infections frequently produce colored secretions. 2
• Do not use over-the-counter cold medications containing multiple ingredients without checking for acetaminophen content, as doubling up can cause severe liver damage. 3

Specific Timeline Guidance

Day 1-3 (Current): Remain off work, focus on symptomatic treatment, obtain throat culture if not already done, monitor temperature regularly. 1, 2

Day 4-7: If fever resolves and symptoms substantially improve without antibiotics, you likely have viral URTI and can return to work once fever-free for 24 hours. 1, 2

If GAS confirmed: Start antibiotics immediately, remain off work for 24 hours after first dose, then return once fever-free and symptoms improving. 1

If symptoms worsen or persist beyond 7-10 days: Seek medical re-evaluation for possible bacterial superinfection or alternative diagnosis. 2