Most Likely Diagnosis: Acute Viral Upper Respiratory Tract Infection (Common Cold)
This presentation of nasal congestion, cough, myalgia, and muscle stiffness without fever is most consistent with an acute viral upper respiratory tract infection (common cold), and should be managed with symptomatic treatment only—antibiotics are NOT indicated. 1
Why This Is NOT Pneumonia or Bacterial Infection
The absence of fever significantly reduces the likelihood of pneumonia, as pneumonia typically requires acute cough PLUS fever >4 days, new focal chest signs, dyspnea, or tachypnea 1
Nasal congestion actually argues AGAINST pneumonia as the primary diagnosis, since pneumonia characteristically presents with fever and absence of upper respiratory tract symptoms 1
The combination of nasal congestion with cough and body aches is the hallmark presentation of the common cold, which is characterized by nasal symptoms with or without fever, throat irritation, and cough 1
Myalgia (body aches) and muscle stiffness are common systemic symptoms of viral upper respiratory infections and do not indicate bacterial infection 2, 3
When Chest X-Ray Is NOT Needed
Do not order a chest radiograph unless you suspect pneumonia based on: acute cough PLUS one of the following: new focal chest signs on examination, dyspnea, tachypnea, or fever >4 days 1
Without these findings, chest radiography is neither feasible nor cost-effective, as only 5-10% of patients with acute cough have pneumonia 1
This patient has none of the required criteria for imaging 1
First-Line Management: Symptomatic Treatment Only
Antibiotics are NOT indicated for acute viral upper respiratory tract infections, as this is almost certainly a self-limited viral illness 1, 2
Specific Symptomatic Treatments:
First-generation antihistamine/decongestant combination (such as brompheniramine with sustained-release pseudoephedrine) for nasal congestion and cough 4, 1
Naproxen 220-440 mg twice daily for body aches, muscle stiffness, and any chest wall pain from coughing 4, 1, 5
Dextromethorphan 60mg for cough suppression if cough is bothersome 1
Simple remedies like honey and lemon can also be used for cough 1
Adequate fluid intake and rest 1
Critical Pitfalls to Avoid
Do not prescribe antibiotics based solely on colored nasal secretions, body aches, or cough—these are normal features of viral URIs and do not indicate bacterial infection 1, 3
Do not use newer-generation nonsedating antihistamines (like loratadine or cetirizine) for acute cough, as they are ineffective and should not be used 4
Do not diagnose "acute bronchitis" unless you have ruled out the common cold first, as this terminology implies a bacterial cause to many patients and leads to inappropriate antibiotic prescribing in 65-80% of cases 1
When to Reassess
Reassess if symptoms worsen or persist beyond 3 weeks, as this may indicate complications or an alternative diagnosis such as asthma, pertussis, or atypical pneumonia 1
Return immediately if: fever develops and persists >4 days, new dyspnea or respiratory distress occurs, or focal chest findings develop 1, 6