What is the likely diagnosis and appropriate management for a patient presenting only with typical common‑cold symptoms such as nasal congestion, rhinorrhea, sore throat, mild cough, low‑grade fever, and malaise?

Diagnosis and Management of the Common Cold

Diagnosis

The diagnosis is acute viral upper respiratory infection (common cold), a self-limited illness characterized by the constellation of nasal congestion, rhinorrhea, sore throat, mild cough, low-grade fever, and malaise. 1 This clinical presentation is caused by viral infection—most commonly rhinovirus—and requires no laboratory testing or imaging for diagnosis. 1

Key Diagnostic Points

• The presence of rhinorrhea, cough, and sore throat strongly indicates viral etiology and argues against bacterial infection. 2
• Purulent or discolored nasal discharge does not indicate bacterial infection—it simply reflects normal inflammatory response with neutrophil activity, not bacteria. 2, 3
• Symptoms typically peak within 3 days and resolve within 7-14 days without treatment. 3, 4
• No diagnostic testing (viral cultures, imaging, or laboratory work) is indicated for uncomplicated cases. 1, 5

When to Suspect Bacterial Superinfection

Consider bacterial complications only if: 1, 2

• Symptoms persist beyond 10 days without improvement
• High fever ≥39°C with purulent nasal discharge or facial pain for ≥3-4 consecutive days
• "Double sickening"—worsening symptoms after initial improvement (typically after 5-7 days)

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Management

Symptomatic treatment is the only appropriate management strategy; antibiotics should never be prescribed for the common cold. 1, 2, 3

First-Line Symptomatic Treatment

Analgesics for pain and fever: 2, 3

• Acetaminophen 1000 mg every 4-6 hours (maximum 4000 mg/24 hours) 2
• Ibuprofen or naproxen as alternatives 3

Nasal saline irrigation: 2, 3

• Safe, low-risk intervention that facilitates clearance of nasal secretions 2
• Provides modest but consistent symptom relief 3

Oral decongestants (pseudoephedrine/phenylephrine): 3

• Effective for nasal congestion relief 3
• Avoid in patients with hypertension or anxiety 3

Combination antihistamine-decongestant products: 1, 3

• First-generation antihistamines (diphenhydramine, brompheniramine) combined with decongestants provide significant symptom relief in 1 out of 4 patients 1
• More effective than newer antihistamines for cold symptoms 3

Optional Adjunctive Therapies

Zinc supplements: 1

• ≥75 mg/day (acetate or gluconate lozenges) started within 24 hours of symptom onset may reduce duration 1
• Weigh benefits against adverse effects (nausea, bad taste) 1

Topical nasal decongestants (oxymetazoline): 3

• May be used for severe congestion 3
• Limit to 3-5 days maximum to prevent rebound congestion (rhinitis medicamentosa) 3

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What NOT to Do

Never prescribe antibiotics for the common cold. 1, 2, 3 Antibiotics:

• Are completely ineffective against viral infections 1
• Do not prevent complications (bacterial sinusitis, otitis media, asthma exacerbation) 1, 2
• Cause significantly more adverse effects than benefits (number needed to harm = 8) 1
• Contribute to antimicrobial resistance 3

Do not use: 1

• Vitamin C or echinacea (no proven benefit) 1
• Intranasal corticosteroids for common cold (no evidence of benefit) 2

In children under 4 years: 6

• Avoid over-the-counter cold medications entirely 6
• Avoid decongestants and antihistamines in children under 3 years 2

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Patient Education and Safety Netting

Counsel patients that: 1, 2, 3

• Symptoms typically last up to 2 weeks and are self-limited 1, 2
• The illness will resolve without antibiotics 2
• Hand hygiene is the most effective prevention method (rhinovirus spreads primarily through direct hand contact) 1, 4

Advise patients to return or follow up if: 1, 2

• Symptoms persist beyond 10 days without improvement 2
• High fever ≥39°C with purulent discharge or facial pain for ≥3-4 consecutive days 2
• Symptoms worsen after initial improvement 2
• Significant breathlessness develops 1
• Hemoptysis occurs 1

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Common Pitfalls to Avoid

• Do not mistake purulent nasal discharge for bacterial infection—discolored mucus is a normal feature of viral colds and does not warrant antibiotics. 2, 3
• Do not prescribe antibiotics for patient satisfaction—this increases harm without benefit. 3
• Do not use topical decongestants beyond 3-5 days—this causes rebound congestion. 3
• Do not order chest X-rays or laboratory tests unless red flags for serious illness are present (hemoptysis, severe systemic illness, suspected pneumonia). 1