RISK FACTORS : Exposure to infected individuals, Touching oneβs nose or conjunctiva with contaminated fingers, Allergic disorders
GENERAL MEASURES :
β’ Rest, fluids, and symptomatic measures
β’ Reassure that usual course is 6-10 days
β’ Humidify inspired air
β’ Discontinue tobacco and alcohol products (if not already done)
β’ In infants, clear nasal passages with a bulb syringe, position mattress at 45Β°, use saline nasal drops
ACTIVITY : Up as tolerated with increased rest in the first few days
DIET: Encourage fluids
PATIENT EDUCATION:
β’ Reassure that colds are ubiquitous and a normal part of human existence
β’ Spread is primarily via hand-to-hand transmission of virus contaminated nasal secretions; persons with colds
touch their nose and eyes and then touch others
β’ Small-particle aerosols released in talking, coughing, and sneezing do not travel very far and contain only a
low concentration of rhinovirus
β’ Rhinovirus survives for hours on the hands and hard surfaces, but does not survive long on porous surfaces
such as tissues
β’ Individual susceptibility to colds, depends in large part, on pre-existing antibody levels
β’ Serum immunity lasts for years, but most individuals gain little protection against future colds due, in part, to
the large number of viral serotypes and the antigenic drift that occurs over time in some viral types (rhinovirus,
influenza)
β’ Educate about the expected course and symptomatic measures
β’ Advise patients to contact you if they develop dyspnea, productive cough, temperature > 102Β°F (38.9Β°C), or
shaking chills
DRUG(S) OF CHOICE :
. No cure or practical preventive measure documented. Medications targeting a particular symptom reduce the likelihood of adverse systemic effects
. Topical decongestants (sympathomimetics) reduce edema and swelling of the nasal mucosa, promote
drainage, and reduce nasal airfl ow resistance. Preferred over oral because of minimal systemic effects.
Sprays preferred over drops in ages > 6.
. Oxymetazoline
- Adults and children ages 6-12: 0.05% solution, 2 or 3 sprays in each nostril bid
- Children ages 2-6: 0.025% solution, 2 or 3 drops in each nostril bid
- Rebound congestion (rhinitis medicamentosa) unlikely if used < 5 days
. Topical anticholinergics. Control rhinorrhea but do not relieve nasal congestion or sneezing
. Ipratropium: Adults and children >11: 0.06% solution, 2 sprays to each nostril TID for 4 days
. Oral decongestants (sympathomimetics). Advantages over topical decongestants: longer duration of action,
lack of local irritation and no risk of rhinitis medicamentosa
. Pseudoephedrine
- Adults: 60 mg q4-6h (120 mg sustained release q12h)
- Children ages 6-12: 30 mg q4-6h
- Children 2-5: 15 mg q4-6h
. Antihistamines. Histamine does not play a significant role in the common cold, but are safe and effective in
alleviating sneezing and rhinorrhea. Their perceived benefit may come from anticholinergic effects, drying
nasal and pharyngeal secretions and sedative effects promoting rest.
. Chlorpheniramine
. Adults: 4 mg q4-6h (or 8 mg tid, 12 mg bid)
. Children ages 6-12: 2 mg q4-6h
. Children ages 2-6: 1 mg q4-6h
. Cough suppressants. Cough most likely due to irritation of tracheobronchial receptors by post-nasal drip and may therefore benefi t from decongestants. If nonproductive or interferes with sleep or normal activities, a cough suppressant is indicated. Codeine and dextromethorphan exhibit comparable effi cacy. Adverse effects: drowsiness and GI upset.
. Codeine
- Adults: 10-20 mg q4-6h
- Children ages 6-12: 5-10 mg q4-6h
- Children ages 2-6: 2.5-5 mg q4-6h
. Dextromethorphan
- Adults: 10-30 mg q4-8h
- Children ages 6-12: 15 mg q6-8h
- Children ages 2-6: 2.5-7.5 mg q4-8h
. Expectorants. Though commonly employed, efficacy not proven
. Guaifenesin
- Adults: 100-400 mg q4h
- Children ages 6-12: 100-200 mg q4h
- Children ages 2-5: 50-100 mg q4h
ALTERNATIVE DRUGS :
. Many mouthwashes, gargles and lozenges are promoted to relieve the pain of sore throat. The demulcent
effects of hard candy, gargling with warm saline, and products with anesthetics (e.g., benzocaine or phenol),
may provide pain relief.
. Aromatic oils (e.g., menthol, camphor, eucalyptus), when applied topically or taken in a lozenge, produce
a sensation of increased airfl ow in the absence of a significant change in airfl ow resistance.
. Antibacterials are of no value
. Antivirals
. Interferon. Prevents viral invasion of mucosa to prevent colds; side effects include nasal irritation or bleeding in about 10% of patients; may be useful in groups that have close contact
. Zinc chloride. Prevents viral replication in vitro, but efficacy of lozenges unproven
. Vitamin C (ascorbic acid)
. No preventative effects and only a modest (average 23%) reduction in the severity and duration of Symptoms.
. Precipitation of urate, oxalate, or cystine stones has been seen, and urine glucose monitoring may be
inaccurate in individuals taking large doses
. Interferes with stool guaiac testing
PATIENT MONITORING : Patients should contact their physician if they develop fever associated
with systemic symptoms, diffi culty breathing, dyspnea, and/or purulent drainage
PREVENTION/AVOIDANCE : Frequent hand washing and avoiding touching the face may help
prevent colds
POSSIBLE COMPLICATIONS:
β’ Lower respiratory tract infection
β’ Bronchial hyperreactivity
β’ May lead to decompensation in patients with asthma and chronic lung disease
β’ Otitis media (2% of colds)
β’ Acute sinusitis (0.5% of colds)
β’ Pneumonia
β’ Rhinitis medicamentosa
EXPECTED COURSE/PROGNOSIS: Complete recovery expected within 3-10 days