Management of a 13-Year-Old with 2-Week Runny Nose and Cough
This is most likely a viral upper respiratory tract infection that does not require antibiotics.
Given the 2-week duration of symptoms with stable vital signs, clear chest sounds, and no focal findings, this presentation is consistent with a prolonged viral upper respiratory infection that should be managed supportively without antibiotics. 1, 2
Clinical Assessment and Diagnosis
This patient's presentation does not meet criteria for acute bacterial sinusitis, which requires one of three specific patterns 1:
- Persistent symptoms: Nasal discharge or daytime cough for >10 days without improvement
- Worsening symptoms: New or worsening nasal discharge, cough, or fever after initial improvement
- Severe symptoms: Fever ≥102.2°F (39°C) with purulent nasal discharge for ≥3 consecutive days
Your patient has had symptoms for 2 weeks but lacks the severe presentation (fever was only present last evening, not for 3 consecutive days) and you don't describe worsening after improvement. 1
The recent fever with body aches could represent influenza, but at 2 weeks into the illness, this is more likely a secondary viral infection or the natural course of a prolonged viral URI. 3
Recommended Management
Supportive care only is appropriate 2:
- Acetaminophen or ibuprofen for fever and body aches 4
- Adequate hydration 5
- Reassurance that most viral URIs resolve without intervention 2
Do not prescribe antibiotics. Antibiotic treatment of nonspecific upper respiratory tract infections does not enhance illness resolution and purulent secretions do not predict bacterial infection or benefit from antibiotics. 2
When to Reconsider or Escalate
Prescribe antibiotics only if the patient develops 1:
- Symptoms persisting beyond 10 days total without any improvement
- Clear worsening after initial improvement (new fever, increased nasal discharge)
- High fever ≥102.2°F with purulent discharge for 3+ consecutive days
If antibiotics become indicated, use amoxicillin with or without clavulanate as first-line therapy. 1
Consider influenza testing and treatment if 6:
- The patient presents within 48 hours of symptom onset during flu season
- Oseltamivir can reduce illness duration by approximately 1 day when started early 6
- However, at 2 weeks into illness, antiviral therapy is no longer indicated 6
Important Caveats
Avoid over-the-counter cough and cold medications in this age group, as efficacy is not well-established and the American Academy of Pediatrics has raised safety concerns, particularly in younger children. 5
Do not obtain a chest radiograph unless the patient develops respiratory distress, focal chest findings, or high fever with tachypnea, as the chest sounds are clear and vital signs are stable. 1
Purulent nasal discharge alone does not indicate bacterial infection - this is a common misconception that leads to inappropriate antibiotic prescribing. 2
Follow-Up
Advise the patient/family to return if 5:
- Symptoms worsen or fail to improve after another 48-72 hours
- High fever develops and persists
- Respiratory distress develops
- Symptoms persist beyond 4 weeks total (at which point chronic cough evaluation would be warranted) 5