What is the best course of treatment for a 22-year-old male patient with chest congestion, respiratory issues, muscle strain, fatigue, and body aches, without fever, and no known chronic medical conditions or allergies?

Management of Acute Respiratory Illness in a Young Adult

For a 22-year-old male with chest congestion, respiratory symptoms, muscle strain, fatigue, and body aches without fever, this presentation is most consistent with a viral upper respiratory tract infection or acute bronchitis that does not require antibiotic therapy. 1

Initial Assessment and Diagnosis

Determine if pneumonia is present, as this is the critical decision point that changes management. Suspect pneumonia only if the patient has acute cough PLUS at least one of the following: new focal chest signs on examination, dyspnea, tachypnea (respiratory rate >20/min), or fever lasting more than 4 days. 1

• In this case, the patient denies fever and you have not described focal chest findings, dyspnea, or tachypnea, making pneumonia unlikely. 1
• Chest radiograph is NOT indicated unless pneumonia is suspected based on the above criteria. 1
• The constellation of chest congestion, fatigue, body aches, and muscle strain without fever is typical of viral acute lower respiratory tract infection (LRTI). 1

When Antibiotics Are NOT Indicated

Do not prescribe antibiotics for this patient. 1 Antibiotic treatment should only be considered in LRTI when there is:

• Suspected or confirmed pneumonia (not present here) 1
• Age >75 years with fever 1
• Cardiac failure, insulin-dependent diabetes, or serious neurological disorder 1
• COPD exacerbation with all three cardinal symptoms: increased dyspnea, increased sputum volume, AND increased sputum purulence 1, 2

This patient meets none of these criteria. 1

Recommended Symptomatic Treatment

For Bothersome Dry Cough

• Prescribe dextromethorphan or codeine if the patient has a dry, bothersome cough. 1
• Do NOT prescribe expectorants, mucolytics, antihistamines, or bronchodilators for acute LRTI in otherwise healthy patients, as these are ineffective. 1

For Body Aches and Muscle Strain

• Recommend naproxen or other NSAIDs, which have been shown in controlled studies to favorably affect cough and reduce symptoms associated with common cold. 1
• Acetaminophen is an alternative for symptom relief. 1

For Chest Congestion

• First-generation antihistamine plus decongestant (such as chlorpheniramine with pseudoephedrine) has been shown in double-blind placebo-controlled studies to decrease cough severity and hasten resolution of postnasal drip associated with common cold. 1

Patient Monitoring and Safety Net

Instruct the patient to return or contact you if: 1

• Symptoms persist beyond 3 weeks 1
• Fever develops and exceeds 4 days 1
• Dyspnea develops or worsens 1
• New focal chest findings appear 1

Expected clinical course: Most viral LRTI symptoms should show improvement within 3 days of symptom onset. 1 If symptoms worsen or new concerning features develop, reassessment is mandatory. 1

Critical Pitfalls to Avoid

• Do not prescribe antibiotics empirically for viral respiratory infections, as this contributes to antimicrobial resistance without patient benefit. 1
• Do not order chest radiograph unless clinical criteria for pneumonia are met, as this exposes the patient to unnecessary radiation and cost. 1
• Do not prescribe bronchodilators for acute bronchitis in patients without underlying asthma or COPD, as evidence shows no benefit. 1
• Do not use anti-viral treatment empirically, as it is not recommended for suspected influenza unless the patient is high-risk, has symptoms for <2 days, and there is a known influenza epidemic. 1