Viral Upper Respiratory Tract Infection (Common Cold)
This clinical presentation is consistent with an uncomplicated viral upper respiratory tract infection (URI), commonly known as the common cold, which follows the typical progression of viral rhinosinusitis and requires only supportive care—not antibiotics. 1
Clinical Reasoning
The symptom progression you describe follows the classic pattern of viral URI:
- Sore throat on day 1 represents the initial viral invasion of the upper respiratory tract 1
- Runny nose (rhinorrhea) on days 2-3 reflects the peak inflammatory response with increased mucus production 1, 2
- Nasal congestion on day 4 occurs as inflammation and edema develop in the nasal passages 2
This sequential pattern over 4 days is characteristic of viral rhinosinusitis (VRS), which typically peaks within 3 days and begins gradual resolution within 7-10 days. 3, 1
Why This Is NOT Bacterial Infection
Bacterial sinusitis requires one of three specific diagnostic patterns, none of which are present here: 1, 4
- Symptoms persisting >10 days without improvement (you're only at day 4)
- Severe symptoms with high fever >39°C AND purulent discharge AND facial pain for ≥3 consecutive days
- "Double sickening" pattern (worsening after initial improvement)
The discolored nasal discharge that may develop does not indicate bacterial infection—it simply reflects white blood cells and inflammatory debris from the normal viral immune response. 1
Recommended Management
Supportive care only—antibiotics are contraindicated: 3, 1
- Analgesics (acetaminophen or ibuprofen) for sore throat and any discomfort 3
- Saline nasal irrigation to cleanse nasal passages and provide symptomatic relief 3, 5
- Adequate hydration to thin secretions 5
- Rest to support recovery 5
Optional symptomatic treatments if needed: 3
- Oral decongestants (pseudoephedrine) may provide relief if no contraindications exist
- Topical decongestants limited to 3-5 days maximum to avoid rebound congestion
- Intranasal corticosteroids for nasal congestion
Critical Pitfalls to Avoid
Do not prescribe antibiotics for this presentation. Antibiotics are ineffective against viral illness, provide no symptom relief, and cause more harm than benefit through adverse effects and resistance development. 3, 1
Expected Course and Red Flags
Natural history: Symptoms typically resolve within 7-10 days, though may persist up to 2 weeks. 1
Return for evaluation if: 1, 4
- Symptoms persist beyond 10 days without improvement
- Symptoms worsen after initial improvement
- High fever >39°C develops with severe unilateral facial pain
- Severe headache with neck stiffness, vision changes, or altered mental status