An otherwise healthy 28-year-old patient presents with a persistent cough for 2 weeks following a viral upper respiratory infection. The patient has no fever, and chest auscultation reveals no abnormal findings. The most appropriate next step in management is:
Acute bronchitis is commonly caused by a viral upper respiratory infection, typically leading to a persistent cough lasting up to three weeks. Given that this patient presents with a cough following a viral illness, lacks fever, and shows no abnormal findings on chest auscultation, the most likely diagnosis is viral acute bronchitis. Antibiotics are not indicated for the treatment of viral acute bronchitis. Most cases resolve independently, and antibiotics are only recommended when there is clear evidence of bacterial superinfection, such as worsening symptoms or purulent sputum. Symptomatic treatment includes hydration, rest, and over-the-counter medications to alleviate symptoms such as cough. A chest X-ray is not routinely required in uncomplicated cases of acute bronchitis. Imaging is typically indicated if there are signs of pneumonia (e.g., fever, difficulty breathing, abnormal lung exam findings). Corticosteroids are generally not recommended for viral acute bronchitis unless there is significant wheezing or underlying chronic respiratory disease (e.g., asthma or COPD).
When managing acute bronchitis, consider the patient’s history (e.g., recent viral URI), lack of fever, and clear lung exam findings to avoid unnecessary tests and treatments. Remember, symptomatic treatment is appropriate for viral infections, while antibiotics should be reserved for cases with clear bacterial signs.