What treatment is recommended for a patient with a 1-day history of headache, throat pain, and rhinorrhea?

Treatment of Acute Upper Respiratory Infection (Common Cold)

This is a self-limited viral illness that requires only symptomatic treatment—antibiotics are not indicated and cause more harm than benefit. 1

Diagnosis and Clinical Context

Your symptoms of headache, throat pain, and rhinorrhea for 1 day represent a classic common cold presentation. 1 The common cold is characterized by:

• Rhinorrhea (runny nose)
• Sore throat
• Headache
• Low-grade fever, malaise, sneezing, and cough may also occur 1

These symptoms typically last up to 2 weeks and are caused by multiple respiratory viruses. 1

Why Antibiotics Should NOT Be Used

Antibiotics provide no benefit for the common cold and significantly increase the risk of adverse effects. 1 Clinical guidelines explicitly state that:

• Symptomatic therapy is the only appropriate management strategy 1
• Antibiotics are not effective for viral upper respiratory infections 1
• The number needed to harm from antibiotics (8) exceeds the number needed to treat (18) even when bacterial infection is present 1

Recommended Symptomatic Treatment

First-Line Options

Combination antihistamine-analgesic-decongestant products provide significant symptom relief in 1 out of 4 patients treated. 1 Specifically:

• Acetaminophen 650-1000 mg every 4-6 hours for headache and throat pain 2
• Ibuprofen 400 mg every 4-6 hours as needed for pain relief 3
• Combination products containing antihistamine + analgesic + decongestant 1

Additional Symptomatic Therapies

Other treatments that may provide relief include:

• Inhaled ipratropium bromide for rhinorrhea 1
• Zinc supplements may reduce symptom duration if started early 1
• Antitussives for cough 1
• Adequate hydration and rest 1

When to Consider Alternative Diagnoses

Red Flags Requiring Reevaluation

You should return for reassessment if:

• Symptoms persist beyond 10 days (consider acute bacterial rhinosinusitis) 1
• High fever >39°C with purulent nasal discharge and facial pain for ≥3 consecutive days 1
• Initial improvement followed by worsening after 5 days ("double sickening") 1

Acute Bacterial Rhinosinusitis Criteria

Reserve antibiotics only for patients meeting specific criteria: 1

• Persistent symptoms >10 days without improvement 1
• Severe symptoms: high fever (>39°C) + purulent discharge + facial pain for ≥3 consecutive days 1
• Worsening symptoms after initial improvement (double sickening pattern) 1

Prevention of Transmission

The most efficient transmission route is direct hand contact, making handwashing the best prevention method. 1 Additional measures include:

• Frequent handwashing with soap and water reduces viral respiratory tract infections by 40% 1
• Alcohol-based hand sanitizers combined with education 1
• Avoiding touching face, especially nose and eyes 1

Expected Clinical Course

Symptoms can last up to 2 weeks—this is normal and does not indicate bacterial infection. 1 You should follow up only if:

• Symptoms worsen rather than gradually improve 1
• Symptoms exceed 2 weeks duration 1
• New severe symptoms develop (high fever, severe facial pain, neurological symptoms) 1

Critical Pitfall to Avoid

Do not use antibiotics for symptom duration alone. The 10-day threshold applies only when symptoms show NO improvement whatsoever, not when symptoms are still present but gradually improving. 1 Most patients with common cold have residual mild symptoms at 10 days that continue to improve—this does not warrant antibiotics. 1