Diagnosis and Treatment of Acute Viral Upper Respiratory Tract Infection
This patient has an acute viral upper respiratory tract infection (URI), likely influenza or another respiratory virus, and should receive symptomatic treatment with analgesics/antipyretics, decongestants, rest, and hydration—antibiotics are not indicated unless bacterial complications develop after 7-10 days. 1, 2
Clinical Diagnosis
The constellation of symptoms—sore throat, cough, phlegm production, rhinorrhea, hoarseness, headache, diaphoresis, fatigue (excessive sleep), and loss of appetite—is classic for viral URI. 1, 3 The negative COVID-19 test effectively rules out SARS-CoV-2, though repeat testing could be considered if symptoms worsen given the 60-78% sensitivity of single RT-PCR tests. 4, 5
Key diagnostic considerations:
Viral etiology is most likely given the symptom cluster and negative COVID-19 test. 1, 6 Common causative agents include influenza, rhinovirus, respiratory syncytial virus, parainfluenza, and other respiratory viruses. 6, 7
The headache is likely secondary to coughing (as the patient notes) and represents a tension-type headache from repeated Valsalva maneuvers during coughing episodes. 5
Hoarseness (fluctuating voice) indicates laryngeal involvement, consistent with viral laryngitis as part of the URI syndrome. 1
Bacterial superinfection is unlikely at this stage unless symptoms persist beyond 7-10 days or demonstrate "double sickening" (initial improvement followed by worsening). 2
Treatment Approach
Symptomatic management is the cornerstone of treatment:
Analgesics/antipyretics: Acetaminophen or ibuprofen for sore throat, headache, body aches, and fever if present. 1 Treat fever if temperature exceeds 38.5°C. 4
Decongestants: Pseudoephedrine or phenylephrine for nasal congestion and rhinorrhea. 4, 1
Antihistamines: May help with rhinorrhea and sneezing if bothersome. 1
Hydration and rest: Essential to support immune function and recovery. 4, 1
Cough management: Dextromethorphan or guaifenesin may provide symptomatic relief, though evidence is limited. 1
Antibiotics are NOT indicated because this is a viral infection—antibiotics only treat bacterial infections and will not help viral URI. 1, 2
When to Consider Antibiotics
Antibiotics should only be considered if:
Symptoms fail to improve within 7-10 days, suggesting possible bacterial sinusitis. 2
"Double sickening" occurs (initial improvement followed by worsening), which significantly increases likelihood of bacterial superinfection. 2
Purulent rhinorrhea persists beyond 10 days with facial pain/pressure. 2
High fever (>39°C) develops after initial symptom period. 3
First-line antibiotic if needed: Amoxicillin with or without clavulanate. 2
Red Flags Requiring Urgent Re-evaluation
The patient should return immediately or seek emergency care if:
Respiratory rate ≥30 breaths/minute or oxygen saturation ≤93%. 4, 5
Persistent high fever despite antipyretics. 4
Chest pain or signs of respiratory distress. 5
Symptoms worsen significantly after initial improvement. 4, 3
Expected Clinical Course
Typical viral URI timeline:
Peak symptoms: Days 2-4 of illness, when inflammatory markers like CRP are highest. 3
Improvement expected: Within 7-10 days for most symptoms. 1, 2
Persistent symptoms: Cough, sputum production, and nasal congestion may persist beyond the acute phase even as systemic symptoms (fever, body aches, fatigue) resolve. 3
Complete resolution: Usually within 2-3 weeks. 1
Work Certificate
A medical certificate for work absence is appropriate given the acute viral illness. The patient should rest at home until fever-free for 24 hours and symptoms are improving to prevent workplace transmission and support recovery. 4
Follow-up Recommendations
Recheck in 7-10 days if symptoms persist or worsen, or sooner (48-72 hours) if: