This patient should be treated with a combination antihistamine and decongestant, such as chlorpheniramine-pseudoephedrine. This otherwise healthy nonsmoker has acute cough most likely caused by viral upper respiratory tract infection. His examination findings do not implicate lower respiratory tract infection, and there is no evidence of reactive airways disease. The treatment of acute viral upper respiratory tract infections is based on symptoms. First-generation antihistamine and decongestant preparations (such as chlorpheniramine-pseudoephedrine), inhaled ipratropium, and cromolyn sodium may be used to decrease sneezing and rhinorrhea.

Routine antibiotic treatment of uncomplicated viral upper respiratory tract infections in immunocompetent patients is ineffective, associated with many adverse effects, contributes to antibiotic resistance, and represents low value care; it is therefore not recommended. The purulent nature of this patient's sputum does not reliably differentiate between bacterial and viral causes of infection, and he should not be prescribed an antibiotic.

Codeine is less useful as a cough suppressant in acute cough, as in this patient. Studies suggest, however, that opioids may decrease cough frequency and severity in patients with chronic cough.

This patient has no wheezing or history of reactive airways disease; therefore, inhaled β₂-agonists, such as albuterol, are not indicated.