What is the recommended treatment for a patient presenting with Coryza (common cold), considering symptoms such as fever, headache, body aches, and nasal congestion?

Treatment of Coryza (Common Cold)

Do not prescribe antibiotics for coryza—this is a self-limited viral illness that resolves without antimicrobial therapy, and antibiotics provide no benefit while increasing the risk of adverse effects. 1

Symptomatic Management Strategy

First-Line Analgesics and Antipyretics

• Ibuprofen 400 mg every 4-6 hours (maximum 1200 mg/day for OTC use) is specifically recommended for fever, headache, and body aches associated with viral upper respiratory infections 2, 3
• Acetaminophen is an equally effective alternative for patients with contraindications to NSAIDs 1
• Never use aspirin in children under 16 years due to the risk of Reye's syndrome 2, 3

Nasal Congestion Relief

• Combination antihistamine-analgesic-decongestant products provide significant symptom relief in 1 out of 4 patients 1
• Pseudoephedrine temporarily relieves nasal congestion due to the common cold 4
• Topical decongestants (e.g., xylometazoline) can be used but limit to 3-5 consecutive days maximum to avoid rebound congestion and rhinitis medicamentosa 1
• Saline nasal irrigation may provide modest symptomatic benefit 1

Additional Symptomatic Therapies

• Inhaled ipratropium bromide for rhinorrhea 1
• Antitussives for cough control 1
• Zinc supplements (if started within 24 hours of symptom onset) may reduce symptom duration, though adverse effects include nausea and bad taste 1

Supportive Care Measures

• Adequate rest and hydration 1
• Warm facial packs and steamy showers 1
• Sleeping with head of bed elevated 1
• Avoid smoking and environmental irritants 1

Expected Clinical Course and Follow-Up

Duration of Symptoms

• Symptoms typically last up to 2 weeks and patients should be counseled that this is normal 1
• Complete resolution without intervention is the expected outcome 1

Red Flags Requiring Immediate Reassessment

Instruct patients to return or seek urgent care if they develop:

• Difficulty breathing or painful/labored respiration 3
• Altered mental status (somnolence, disorientation, confusion) 3
• Persistent fever for 4-5 days without improvement or with worsening symptoms 2, 3
• Symptoms persisting beyond 10 days (suggests possible bacterial sinusitis) 1
• "Double worsening" pattern where symptoms improve then worsen after 5-10 days (suggests bacterial sinusitis) 1, 5
• High fever (>39°C) with purulent nasal discharge and facial pain for ≥3 consecutive days (suggests bacterial sinusitis) 1

Critical Pitfalls to Avoid

Antibiotic Misuse

• Antibiotics do not prevent complications of the common cold (bacterial sinusitis, asthma exacerbation, otitis media) 1
• The number needed to harm from antibiotics (NNH = 8) exceeds any potential benefit in viral upper respiratory infections 1
• Reserve antibiotics exclusively for patients meeting specific criteria for bacterial sinusitis (symptoms >10 days, severe symptoms with high fever, or double worsening pattern) 1

Medication Safety

• Antihistamines alone have more adverse effects than benefits in non-allergic patients and may worsen congestion by drying nasal mucosa 1
• Avoid prolonged use of topical decongestants beyond 3-5 days 1
• Use ibuprofen at the lowest effective dose for the shortest duration necessary 2, 3

Distinguishing Viral from Bacterial Infection

• Coryza (rhinorrhea), cough, and conjunctivitis are viral features that argue against bacterial infection 1
• Purulent nasal discharge alone does not indicate bacterial infection—it is normal in viral colds 1
• Bacterial sinusitis requires specific timing criteria (>10 days duration, severe onset, or double worsening), not just purulent discharge 1, 5