Fever with Productive Cough — Practical LRTI Prescription
A practical OPD prescription for a 60-year-old male with fever, productive cough, chest congestion, and mucus stuck in the chest — built around CURB-65 risk stratification, SpO2 assessment, empirical CAP/LRTI treatment, TB screening, red flags, and 48–72 hour review.
Why This Prescription Matters
Fever with productive cough is common, but in an older adult the prescription should not begin until two steps are complete: pneumonia severity assessment and oxygenation assessment. This prescription starts with CURB-65 plus SpO2 to decide whether OPD treatment is safe or admission is needed.
The guide then gives a practical outpatient CAP/LRTI prescription: amoxicillin-clavulanate with atypical cover, penicillin-allergy alternative, mucolytic-expectorant support, bronchodilator logic when wheeze is present, investigations to send the same day, red flags, and a clear follow-up plan.
What You’ll Learn
- Risk stratification first — CURB-65 plus SpO2 before deciding OPD versus admission.
- Empirical CAP/LRTI antibiotic logic — amoxicillin-clavulanate with azithromycin or doxycycline for atypical cover.
- Penicillin-allergy pathway — levofloxacin as a respiratory fluoroquinolone option with TB-masking caution.
- Symptomatic care — paracetamol, mucolytic-expectorant syrup, steam, hydration, and airway-hyperreactivity support.
- Bronchospasm support — when to add salbutamol-ipratropium nebulisation or inhaler treatment.
- Investigations today — chest X-ray, CBC, CRP, glucose/HbA1c, renal function, electrolytes, sputum tests, SpO2, and ECG baseline.
- TB screening discipline — AFB/CBNAAT is important in productive cough in older adults in our setting.
- Follow-up logic — review in 48–72 hours and escalate if fever, hypoxia, breathlessness, haemoptysis, confusion, or poor oral intake appears.
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Subscribe to read the complete LRTI prescription with CURB-65 logic, antibiotic choices, atypical cover, TB screening, red flags, investigations, and 48–72 hour follow-up plan.
This prescription is for clinical learning. Individualise antibiotic choice according to vitals, SpO2, CURB-65 score, chest X-ray, renal function, allergy history, TB suspicion, pregnancy status, local resistance patterns, local protocols, and admission/referral availability.