What is the best management approach for an otherwise healthy adult or child presenting to the Emergency Department (ED) with a one-day history of fever, productive cough, cold symptoms, and sore throat?

Management of Acute Upper Respiratory Infection in the Emergency Department

For an otherwise healthy adult or child presenting to the ED with one day of fever, productive cough, cold symptoms, and sore throat, the best management is symptomatic treatment with antipyretics (acetaminophen or ibuprofen), hydration advice, and discharge home with clear return precautions—antibiotics should not be prescribed. 1

Initial Assessment Priority

The primary focus in the ED should be ruling out serious illness, particularly pneumonia, rather than treating the viral upper respiratory infection itself. 1

Key clinical decision points:

• Assess vital signs: heart rate, respiratory rate, temperature, and oxygen saturation 1
• Perform focused chest examination to identify focal consolidation (rales, egophony, fremitus) 1
• If vital signs are normal (heart rate <100 bpm, respiratory rate <24 breaths/min, temperature <39°C) and chest examination is clear, pneumonia is effectively ruled out and no chest radiography is needed 1, 2

Symptomatic Treatment Recommendations

For Adults:

• Acetaminophen (paracetamol) or ibuprofen for fever, myalgias, and headache 1
• Adequate fluid intake 1
• Rest 1
• Consider short-course topical decongestants, throat lozenges, or saline nasal drops 1
• Combination antihistamine-analgesic-decongestant products provide symptom relief in 1 out of 4 patients 1

For Children:

• Acetaminophen or ibuprofen for fever control 1, 2
• Never aspirin in children under 16 years due to Reye syndrome risk 1, 2
• Adequate fluid intake 1, 2
• Rest 2
• Children under 1 year should be seen by a physician for assessment 1, 2
• Over-the-counter cough and cold medications should not be used in children under 4 years 3, 4

What NOT to Do

Critical management pitfalls to avoid:

• Do not prescribe antibiotics—they are not effective for viral upper respiratory infections and lead to increased adverse effects 1
• The presence of purulent sputum does NOT indicate bacterial infection requiring antibiotics; purulence results from inflammatory cells and occurs with viral infections 1
• Do not order chest radiography in patients with normal vital signs and clear lung examination 2
• Do not use antibiotics prophylactically to prevent complications in otherwise healthy patients 2

Discharge Instructions and Return Precautions

Patients should be instructed to return or seek re-evaluation if they develop:

• Shortness of breath at rest or with minimal activity 1
• Painful or difficult breathing 1
• Coughing up bloody sputum 1
• Drowsiness, disorientation, or confusion 1, 2
• Fever persisting 4-5 days without improvement or worsening 1, 2
• Initial improvement followed by high fever and feeling unwell again (suggests secondary bacterial infection) 1

Expected clinical course:

• Fever typically resolves in 2-4 days 2
• Cough and clear nasal discharge may persist 1-2 weeks 1, 2
• Symptoms lasting beyond 2 weeks warrant re-evaluation 1

Special Populations Requiring Enhanced Vigilance

While the question specifies "otherwise healthy" patients, be aware that certain groups require closer monitoring even if currently appearing well:

• Children under 1 year of age should have physician assessment 1, 2
• Patients with underlying chronic conditions (asthma, COPD, heart failure, immunosuppression) require individualized assessment beyond these recommendations 1

Evidence Quality Note

The recommendation against antibiotics is supported by high-quality guideline evidence from the American College of Physicians and CDC (2016), which explicitly states that antibiotics should not be prescribed for the common cold and are ineffective for acute bronchitis. 1 The British guidelines on influenza-like illness management (2007) provide consistent symptomatic treatment recommendations. 1 The absence of benefit combined with known harms (adverse effects, antibiotic resistance) makes this a clear clinical decision.