Sick Leave Duration for Mild Upper Respiratory Infection
A 2-day sick leave is the appropriate recommendation for an otherwise healthy adult with low-grade fever and mild nasal congestion responsive to antihistamines. 1
Clinical Rationale
This patient presents with classic viral acute nasopharyngitis (common cold) that is self-limited and requires only symptomatic management:
- Viral URIs typically resolve within 7-10 days, with most patients experiencing significant improvement within the first few days 1, 2
- The patient's symptoms are mild (low-grade fever, mild congestion) and responsive to antihistamines, indicating uncomplicated disease 1
- No antibiotics or advanced interventions are indicated for this presentation 1, 3
Why Not One Week?
Granting unnecessary extended sick leave for mild, self-limited viral illness:
- Does not align with evidence-based recovery timelines for uncomplicated viral URIs 1, 2
- Creates unrealistic expectations about illness duration and work capacity 4
- The patient can perform normal activities with symptomatic relief from over-the-counter medications 1
Appropriate Management Plan
Symptomatic treatment only:
- Acetaminophen or NSAIDs for fever and discomfort 1
- Continue antihistamines for nasal congestion (though evidence for efficacy in viral URIs is limited) 3
- Nasal saline irrigation for symptom relief 1
- Adequate hydration and rest 5
Return-to-work guidance:
- 2 days off allows initial recovery while symptoms are most bothersome 1, 5
- Patient can return to work with symptomatic management (antihistamines, analgesics as needed) 1
- Recommend infection control measures: hand hygiene, masking if symptomatic around others 5
Safety-Net Return Precautions
Instruct the patient to seek re-evaluation if:
- Symptoms persist ≥10 days without improvement (suggests possible bacterial superinfection) 1, 2, 3
- High fever ≥39°C (102°F) with purulent nasal discharge for 3-4 consecutive days 1, 2
- "Double-sickening" pattern: initial improvement followed by worsening within 10 days 1, 2, 5
- Development of severe unilateral facial pain, orbital symptoms, or altered mental status 2
Common Pitfall to Avoid
Do not prescribe extended sick leave based solely on patient request when clinical severity does not warrant it. 1 The physician's role is to provide evidence-based recommendations that balance patient comfort with realistic recovery expectations. Mild viral URIs with good symptomatic response do not require prolonged work absence. 1, 5
The correct answer is A: Give 2 days sick leave.