What is the recommended treatment for a 27-year-old male presenting with a sore throat, sneezing, and coughing?

Management of Acute Upper Respiratory Tract Infection

This 27-year-old male with sore throat, sneezing, and coughing most likely has a viral upper respiratory infection (common cold) and should be treated with symptomatic therapy only—antibiotics are not indicated unless specific criteria for bacterial infection are met.

Initial Assessment and Risk Stratification

Rule Out Bacterial Pharyngitis

• Evaluate for group A streptococcal pharyngitis using clinical criteria 1:
  • Presence of fever
  • Anterior cervical adenopathy
  • Tonsillopharyngeal exudates
  • Absence of cough
• If fewer than 3 Centor criteria are present, testing is not warranted 1
• Only test patients with ≥3 criteria using rapid antigen detection test and/or culture 1
• Antibiotics should only be prescribed if streptococcal testing is positive 1

Important Caveat for Young Adults

• Remain vigilant for Lemierre syndrome in this age group if pharyngitis is severe, as Fusobacterium necrophorum causes 10-20% of pharyngitis cases in adolescents and young adults 1
• Urgent evaluation is needed if severe pharyngitis is accompanied by difficulty swallowing, drooling, neck tenderness, or swelling 1

Recommended Treatment Approach

First-Line: Non-Pharmacological Management

Simple home remedies are the preferred initial approach 1, 2:

• Honey and lemon mixture is the simplest, cheapest, and often effective treatment 1, 2, 3
• Encourage voluntary cough suppression, which may reduce cough frequency through central modulation 1, 2
• Reassure the patient that symptoms typically last less than 2 weeks 1

Symptomatic Pharmacological Therapy

For Sore Throat Pain

• Offer analgesics: aspirin, acetaminophen, NSAIDs, or throat lozenges 1
• Salt water gargles or viscous lidocaine may provide topical relief, though evidence is limited 1

For Cough Suppression (if needed)

Dextromethorphan is the preferred antitussive agent 2, 3:

• Dose: 30-60 mg for optimal cough suppression (standard OTC doses are often subtherapeutic) 2, 3
• Maximum daily dose: 120 mg 3
• Caution: Check combination products to avoid excessive acetaminophen 2, 3
• Codeine and pholcodine are NOT recommended—they have no greater efficacy than dextromethorphan but significantly more adverse effects 2, 3

Alternative Cough Treatments

• Menthol inhalation provides acute but short-lived cough suppression 2, 3
• First-generation sedative antihistamines may be useful specifically for nocturnal cough, though they cause drowsiness 2, 3

For Nasal Congestion

• Combination antihistamine-analgesic-decongestant products provide symptom relief in 1 out of 4 patients 1
• Other options include inhaled ipratropium bromide, inhaled cromolyn sodium 1

What NOT to Do

Avoid Inappropriate Antibiotic Use

• Over 60% of adults with sore throat receive unnecessary antibiotics 1
• Antibiotics provide minimal benefit even for confirmed streptococcal pharyngitis (NNT = 6 at 3 days, NNT = 21 at 1 week to reduce symptoms by 1-2 days) 1
• Antibiotics do NOT prevent complications in viral infections 1

Common Prescribing Pitfalls

• Do not prescribe subtherapeutic doses of dextromethorphan (standard OTC dosing is often inadequate) 2, 3
• Avoid codeine-based antitussives due to poor benefit-to-risk ratio 2, 3
• Do not use promethazine for cough—it has no established efficacy for cough suppression 3

When to Escalate Care

Refer or investigate further if 1, 2:

• Cough persists beyond 3 weeks 2
• Hemoptysis is present 2
• Breathlessness is increasing 1, 2
• Prolonged fever with malaise and purulent sputum 2
• Severe pharyngitis with difficulty swallowing, drooling, or neck swelling 1

Patient Education

Key counseling points 1:

• Symptoms typically resolve within 1-2 weeks 1
• Antibiotics are usually not needed and may cause adverse effects 1
• Practice good hand hygiene to prevent spread 1
• Return if symptoms worsen or exceed expected recovery time 1