What is the treatment for a patient presenting with cough, fever, chills, sore throat, postnasal drip (PND), rhinorrhea, and a persistent cough lasting 5 days?

From the Guidelines

For symptoms of cough, fever, chills, sore throat, post-nasal drip (PND), and rhinorrhea lasting 5 days, the recommended treatment is primarily supportive care as this presentation suggests a viral upper respiratory infection. The patient should start with acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for fever and pain relief, as suggested by the guidelines for managing common cold symptoms 1. Staying well-hydrated and getting plenty of rest are also crucial. For symptomatic relief, the use of saline nasal sprays for congestion, honey-based cough syrups or lozenges for sore throat and cough, and considering an over-the-counter antihistamine like cetirizine (Zyrtec) 10mg daily or diphenhydramine (Benadryl) 25-50mg every 6 hours for post-nasal drip can be beneficial. A cool-mist humidifier may also help ease respiratory symptoms.

Most viral respiratory infections resolve within 7-10 days without antibiotics, and the use of antibiotics in such cases is not recommended unless there are signs of bacterial infection, such as persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1. However, if symptoms worsen after 7 days, include difficulty breathing, persistent high fever above 101°F despite medication, or if the patient has underlying conditions like asthma or COPD, seeking medical attention is advised as a bacterial infection may have developed, requiring prescription medication.

The guidelines from the American College of Physicians and the Centers for Disease Control and Prevention emphasize the importance of reserving antibiotic treatment for acute rhinosinusitis for patients with specific criteria, highlighting the need for a judicious approach to antibiotic use to minimize adverse effects and promote high-value care 1. The management of postinfectious cough, which may occur after an acute respiratory infection, also does not typically involve antibiotics unless a bacterial cause is identified, and supportive care along with consideration of treatments like inhaled ipratropium or corticosteroids may be recommended 1.

Given the potential for complications and the importance of appropriate management, it is essential to follow up with a clinician if symptoms worsen or exceed the expected time of recovery, ensuring that any underlying conditions are properly addressed and that the risk of antibiotic resistance is minimized.

From the FDA Drug Label

Warnings ... Stop use and ask a doctor if ... cough lasts more than 7 days, cough comes back, or occurs with fever, rash or headache that lasts. The patient has a cough that has lasted for 5 days and is accompanied by fever, which may be a sign of a serious condition.

• The patient should stop use of Dextromethorphan and ask a doctor because the cough is accompanied by fever 2.
• The patient's symptoms may require a different treatment approach.

From the Research

Treatment Options

• The symptoms described, such as cough, fever, chills, sore throat, PND, rhinorrhea, and cough, are common symptoms of the common cold or COVID-19 3, 4.
• For the common cold, antihistamine-decongestant-analgesic combinations may provide some relief, but the evidence for their effectiveness is limited 3.
• A fixed-dose combination of paracetamol, chlorphenamine, and phenylephrine was found to be safe and effective in the symptomatic treatment of the common cold or flu-like syndrome in adults 5.

Considerations

• The use of over-the-counter (OTC) medications such as antihistamines, cough medicines, and decongestants can be misused, and healthcare professionals should be vigilant and design preventative actions 6.
• The presence of anosmia or ageusia may be a useful indicator of COVID-19, while the presence of cough also supports further testing 4.
• Combinations of symptoms with other readily available information such as contact or travel history, or the local recent case detection rate may prove more useful in diagnosing COVID-19 4.

Potential Treatments

• Antihistamine-decongestant combinations may be effective in reducing the duration of symptoms and alleviating symptoms of the common cold 3.
• Analgesic-decongestant combinations may also be effective in reducing symptoms, but the evidence is limited 3.
• A fixed-dose combination of paracetamol, chlorphenamine, and phenylephrine may be a safe and effective treatment option for the common cold or flu-like syndrome in adults 5.