What is the recommended treatment for a patient presenting with a slight fever, headache, body aches, and a dry cough?

Treatment Recommendation for Mild Viral Upper Respiratory Infection with Fever, Headache, Body Aches, and Dry Cough

For your patient with slight fever, headache, body aches, and dry cough, prescribe ibuprofen 400-600 mg three times daily for 3-5 days for fever and body aches, combined with honey (1-2 teaspoons as needed) for cough suppression, and ensure adequate hydration with warm fluids. 1, 2

Clarification on Cough Type

You are correct to distinguish between dry and productive cough. For dry cough specifically, antitussive therapy is appropriate, whereas productive cough requires different management. 1 The medications discussed (dextromethorphan, ibuprofen) are suitable for this patient's dry cough presentation.

Complete Treatment Regimen

For Fever, Headache, and Body Aches

Primary medication: Ibuprofen

• Dose: 400-600 mg orally 2, 3
• Frequency: Three times daily (every 8 hours) 2
• Duration: 3-5 days or until symptoms resolve 4
• Rationale: NSAIDs like ibuprofen provide superior relief for headache, malaise, myalgia, and fever compared to paracetamol alone 2, 3

Alternative option: Paracetamol/Ibuprofen combination

• Dose: Paracetamol 500 mg + Ibuprofen 150 mg 3
• Frequency: As needed, up to three times daily
• Note: This combination shows faster onset (within 1 hour) for bacterial-type fevers, though your patient likely has viral illness 3

For Dry Cough

First-line: Honey

• Dose: 1-2 teaspoons as needed 1, 5
• Frequency: Can be taken multiple times daily, especially before bedtime
• Contraindication: Do not use in children under 1 year of age 1
• Rationale: Honey is the simplest, cheapest, and recommended first approach for cough symptom relief 1

If honey insufficient: Dextromethorphan

• Dose: 30 mg orally 1
• Frequency: Every 6-8 hours as needed (maximum 120 mg/24 hours)
• Note: Standard over-the-counter doses (15-30 mg) may be subtherapeutic; 60 mg shows maximum effect in meta-analyses, but start with lower doses 1
• Duration: 3-5 days maximum

Supportive Measures (Essential Components)

• Hydration: Encourage regular fluid intake, particularly warm liquids, which help through central modulation of the cough reflex 1, 5
• Positioning: Advise sitting upright rather than lying flat, as this increases peak ventilation and makes coughing more effective 1, 5
• Voluntary cough suppression techniques can reduce cough frequency 1

What NOT to Prescribe

Explicitly avoid:

• Antibiotics: Completely ineffective for viral infections, provide no benefit, and contribute to antibiotic resistance 1, 2
• Codeine or pholcodine: NOT recommended due to significant adverse effects without greater efficacy than dextromethorphan 1
• Newer-generation antihistamines (loratadine, cetirizine, fexofenadine): Completely ineffective for common cold symptoms 2

Consider avoiding chlorpheniramine in this case, as first-generation antihistamines are primarily beneficial for nasal congestion and postnasal drainage, which your patient does not have 2

Expected Clinical Course and Red Flags

Normal course:

• Acute viral cough typically lasts 2-3 weeks and resolves without specific treatment 1
• Cough may persist after other symptoms resolve, which is normal 1
• Fever should resolve within 48 hours of starting treatment 2

Return immediately if:

• Fever persists beyond 48 hours after starting treatment 2
• Development of rapid breathing, shortness of breath, or chest pain 1, 5
• Cough worsening after initial improvement 2
• Coughing up blood 1
• Symptoms persisting beyond 3 weeks 1

Special Considerations

If influenza suspected:

• Consider oseltamivir if patient presents within 48 hours of symptom onset, which may decrease complications and improve outcomes 1
• However, for simple viral upper respiratory infection without high-risk features, symptomatic treatment as outlined above is appropriate

Comorbidity precautions:

• Use ibuprofen cautiously in patients with hypertension, as it may elevate blood pressure 2
• In diabetic patients, monitor blood glucose more frequently during acute illness 2

Summary Prescription

Written prescription:

1. Ibuprofen 400 mg tablets: Take 1-2 tablets (400-600 mg) orally three times daily with food for 3-5 days
2. Honey: 1-2 teaspoons as needed for cough, especially before bedtime
3. Increase oral fluid intake, particularly warm liquids
4. Maintain upright positioning when symptomatic

If cough persists despite honey: 5. Dextromethorphan 30 mg: Take 1 dose every 6-8 hours as needed (maximum 4 doses/24 hours) for up to 5 days

This regimen addresses all presenting symptoms with evidence-based treatments while avoiding ineffective or potentially harmful medications. 1, 2, 5, 3