How to manage symptoms of a respiratory infection with sore throat, post-nasal drainage, body aches, nausea, and productive cough?

Management of Acute Viral Upper Respiratory Tract Infection

This 39-year-old has a typical viral upper respiratory tract infection (common cold) that does not require antibiotics, and symptomatic treatment with analgesics and supportive care is the appropriate management.

Clinical Diagnosis

This presentation is consistent with an acute viral rhinosinusitis/upper respiratory tract infection based on:

• Symptom duration of 3 days with sore throat, post-nasal drainage, runny nose, and cough 1
• Colored sputum (green/yellow) does NOT indicate bacterial infection - this is a common misconception; viral infections commonly produce purulent-appearing nasal discharge due to white blood cells and desquamated epithelium 1
• Constitutional symptoms (body aches, chills, sweating without documented fever, nausea) are typical of viral illness 2
• No fever documented - bacterial sinusitis typically presents with fever >39°C 1
• **Symptom duration <10 days** - bacterial rhinosinusitis should only be considered when symptoms persist >10 days without improvement, are severe (fever >39°C with purulent discharge for >3 consecutive days), or show "double worsening" after initial improvement 1

Antibiotics Are NOT Indicated

Do not prescribe antibiotics for this patient. 1

• Viral upper respiratory infections account for the vast majority of these presentations and are self-limited, resolving within 7-10 days 1, 2
• Antibiotics provide no benefit for viral infections and expose the patient to unnecessary adverse effects and contribute to antimicrobial resistance 1
• The colored sputum is NOT an indication for antibiotics - this is inflammatory debris, not bacterial infection 1
• Acute bacterial rhinosinusitis complicates viral URIs in fewer than 2% of cases 1

Recommended Symptomatic Management

Pain and Discomfort Relief

• Analgesics: Acetaminophen, aspirin, or NSAIDs (ibuprofen, naproxen) for body aches, sore throat, and headache 1
• Throat lozenges for sore throat relief 1
• Salt water gargles may provide additional symptomatic relief 1

Nasal and Respiratory Symptoms

• Inhaled ipratropium may help reduce rhinorrhea and post-nasal drainage in post-infectious cough 1
• Dextromethorphan as a cough suppressant if cough is significantly bothersome 3
• Nasal saline irrigation can help with nasal congestion and post-nasal drainage 1

Supportive Care

• Adequate hydration 1
• Rest as needed 1
• Humidified air may provide comfort 1

Expected Clinical Course and Follow-Up

• Typical duration: Symptoms peak at days 2-3 and resolve within 7-10 days, though 25% of cases may last longer 2
• Return if: Symptoms persist beyond 10 days without improvement, worsen after initial improvement ("double sickening"), or develop high fever (>39°C) with severe facial pain for >3 consecutive days 1
• These "red flags" would suggest possible bacterial superinfection requiring re-evaluation 1

Critical Pitfalls to Avoid

• Do not prescribe antibiotics based on colored nasal discharge alone - this is the most common error and leads to unnecessary antibiotic use 1
• Do not obtain imaging (CT, X-ray) for uncomplicated acute rhinosinusitis - it cannot differentiate viral from bacterial causes and increases costs 4-fold without improving outcomes 1
• Do not diagnose bacterial sinusitis before 10 days of persistent symptoms without improvement 1
• Consider alternative diagnoses if symptoms are atypical: cardiac failure in elderly patients with dyspnea, pulmonary embolism with sudden onset dyspnea, or exacerbation of underlying asthma/COPD 1, 4