Management of Acute Upper Respiratory Tract Infection with Sore Throat and New-Onset Cough
This 33-year-old woman has an acute viral upper respiratory tract infection that requires only symptomatic treatment—antibiotics are not indicated at this time. 1, 2
Immediate Clinical Assessment
Obtain vital signs immediately to assess for any concerning features that would change management, including temperature, heart rate, respiratory rate, and oxygen saturation. 1 Based on the normal physical examination provided, this patient does not have red flags requiring urgent intervention or chest radiography. 2
Red Flags That Would Require Chest X-Ray (Not Present in This Case)
- Fever >38°C persisting beyond 4 days 1
- Pleuritic chest pain 1
- Tachycardia or tachypnea 1
- Respiratory distress 1
- Hemoptysis 2
Diagnosis
This presentation is consistent with an acute viral upper respiratory tract infection (common cold). 3, 4 The 1-day duration of sore throat followed by productive cough with clear sputum and chills represents typical viral pharyngitis progressing to acute bronchitis. 3, 5
Why Antibiotics Are NOT Indicated
- Most sore throats (>80%) are viral in origin and do not require antibiotics 3
- Clear/transparent sputum indicates viral infection, not bacterial 5
- Duration <3 weeks defines acute cough, which is typically viral and self-limiting 3, 2
- The patient lacks criteria for bacterial pharyngitis testing: no persistent fever, no anterior cervical adenitis, no tonsillopharyngeal exudates 3
- Symptoms have been present for only 1 day—bacterial complications typically require >5-10 days of symptoms 1, 4
Recommended Treatment Plan
Symptomatic Management (First-Line)
Prescribe a first-generation antihistamine/decongestant combination (such as brompheniramine with sustained-release pseudoephedrine) to reduce throat drainage and cough. 3, 1, 2
Add naproxen 220-440 mg twice daily for sore throat pain and systemic symptoms. 1, 2
Recommend acetaminophen or ibuprofen for fever and additional pain relief as needed. 2, 6
Advise adequate fluid intake to thin secretions and maintain hydration. 1, 2
Suggest honey for cough suppression (if culturally acceptable and no contraindications). 1, 2
What NOT to Prescribe
- Do not prescribe antibiotics—they provide no benefit for viral infections and increase resistance 3, 4
- Do not prescribe newer-generation nonsedating antihistamines—they are ineffective for acute viral cough 3
- The chlorhexidine gargle (Bactodol) already used is reasonable to continue for local throat comfort, though evidence for efficacy is limited 7
Safety Net Instructions
Instruct the patient to return immediately or call if:
- Breathing difficulty or respiratory distress develops 1, 2
- Fever persists beyond 4 days 1
- Symptoms worsen after initial improvement (suggests bacterial superinfection) 4
- Hemoptysis occurs 1
Schedule reassessment if:
- Cough persists beyond 3 weeks (reclassify as subacute cough requiring further evaluation) 1, 2
- Symptoms worsen or fail to improve after 7-10 days (consider bacterial rhinosinusitis or pneumonia) 1, 4
Expected Clinical Course
Reassure the patient that typical viral upper respiratory infections resolve within 1 week, with cough potentially lasting up to 3 weeks. 3 The productive cough with clear sputum is expected and does not indicate bacterial infection requiring antibiotics. 5
Common Pitfalls to Avoid
- Do not prescribe antibiotics based solely on productive cough—sputum color and production do not reliably distinguish viral from bacterial infection in acute presentations 3, 5
- Do not test for Group A Streptococcus in this patient—she lacks the clinical criteria (no persistent fever, no exudates, no anterior cervical adenopathy) that would warrant testing 3
- Do not order chest radiography unless red flag symptoms develop, as this is unnecessary in uncomplicated acute bronchitis with normal vital signs 1, 2