What is the recommended treatment for a 55-year-old patient with a 3-day history of rhinorrhea (runny nose) and throat roughness without odynophagia (painful swallowing)?

Treatment Recommendation for Viral Upper Respiratory Infection

This 55-year-old patient with 3 days of rhinorrhea and throat roughness requires symptomatic treatment only—antibiotics are not indicated and should be avoided. 1

Clinical Diagnosis

This presentation is consistent with the common cold (viral upper respiratory infection):

• Symptom duration of only 3 days strongly indicates viral etiology 1
• Bacterial rhinosinusitis requires symptoms persisting ≥10 days without improvement, severe symptoms (fever >39°C with purulent discharge and facial pain for ≥3 consecutive days), or worsening after initial improvement ("double sickening") 1, 2
• This patient meets none of these criteria for bacterial infection 1, 2

Recommended Treatment Approach

First-Line Symptomatic Management

Provide reassurance that this is a self-limited viral illness that will resolve without antibiotics:

• The common cold typically resolves spontaneously within 7-10 days 1
• Antibiotics provide no benefit for viral infections and cause more harm than good (number needed to harm = 8 vs. number needed to treat = 18 for bacterial sinusitis) 1

Specific Symptomatic Therapies

For nasal congestion (runny nose):

• Oral decongestants (pseudoephedrine or phenylephrine) can reduce nasal congestion effectively 1, 3
• Topical nasal decongestants (oxymetazoline) provide rapid relief but limit use to 3-5 days maximum to avoid rebound congestion 1, 2, 4
• Saline nasal irrigation 2-3 times daily enhances mucociliary clearance 2

For throat roughness:

• Analgesics for discomfort 1
• Increased fluid intake and throat lozenges (general medical practice)

Additional supportive measures:

• Antipyretics if fever develops 1
• Adequate rest and hydration (general medical practice)

Critical Pitfalls to Avoid

Do not prescribe antibiotics:

• Only 0.5-2% of acute rhinosinusitis cases are bacterial 2
• Approximately 30% of common cold visits inappropriately result in antibiotic prescriptions 1
• Antibiotics play no role in preventing complications of viral URIs 1

Do not use topical decongestants beyond 3-5 days:

• Risk of rhinitis medicamentosa (rebound congestion) develops with prolonged use 1, 2
• While some studies show safety up to 4 weeks, clinical guidelines consistently recommend 3-5 day maximum 1, 2, 5

Do not use antihistamines as primary therapy:

• Antihistamines are ineffective for non-allergic viral rhinitis 2
• First-generation antihistamines cause sedation and anticholinergic effects without proven benefit in common cold 1

When to Reassess

Instruct the patient to return if:

• Symptoms persist beyond 10 days without improvement 1, 2
• Severe symptoms develop (high fever >39°C, purulent nasal discharge, facial pain lasting ≥3 consecutive days) 1, 2
• Symptoms initially improve then worsen after 5-7 days (suggesting secondary bacterial infection) 1, 2

At that point, bacterial rhinosinusitis should be considered and antibiotics may be appropriate 1, 2

Prevention Counseling

Recommend hand hygiene:

• Direct hand contact is the most efficient transmission route for respiratory viruses 1
• Proper handwashing with soap or alcohol-based sanitizer when exposed to ill individuals 2