Acute viral nasopharyngitis medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 10: Line 10:


===Palliative Care===
===Palliative Care===
The [[National Institute of Allergy and Infectious Diseases]] suggests getting plenty of rest, drinking fluids to maintain hydration, [[gargling]] with warm salt water, using cough drops, throat sprays, or [[over-the-counter drug|over-the-counter]] pain or cold medicines. Saline nasal drops may help alleviate congestion.<ref name=PDRCC>{{cite web
* The [[National Institute of Allergy and Infectious Diseases]] suggests getting plenty of rest, drinking fluids to maintain hydration, [[gargling]] with warm salt water, using cough drops, throat sprays, or [[over-the-counter drug|over-the-counter]] pain or cold medicines. Saline nasal drops may help alleviate congestion.<ref name="PDRCC">{{cite web
  | title = Common Cold
  | title = Common Cold
  | work = PDRHealth
  | work = PDRHealth
Line 16: Line 16:
  | url = http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=BHG01ID25.xml&contentName=Common+Cold&contentId=30
  | url = http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=BHG01ID25.xml&contentName=Common+Cold&contentId=30
}}</ref>
}}</ref>
 
* The [[American Lung Association]] recommends avoiding coffee, tea or cola drinks that contain [[caffeine]] and avoiding [[alcoholic beverage]]s. Both caffeine and alcohol cause [[dehydration]].
The [[American Lung Association]] recommends avoiding coffee, tea or cola drinks that contain [[caffeine]] and avoiding [[alcoholic beverage]]s. Both caffeine and alcohol cause [[dehydration]].


===Antibiotics===
===Antibiotics===
[[Antibiotics]] do not have any beneficial effect against the common cold. Their use in cases of common cold infection is ineffective and may contribute to [[antibiotic resistance]] of [[bacteria]] present in the patient's body.
* [[Antibiotics]] do not have any beneficial effect against the common cold.  
* Their use in cases of common cold infection is ineffective and may contribute to [[antibiotic resistance]] of [[bacteria]] present in the patient's body.


===Antivirals===
===Antivirals===
There are no approved [[antiviral drug]]s for the common cold.
* There are no approved [[antiviral drug]]s for the common cold.
 
* [[ViroPharma]] and [[Schering-Plough]] are developing an antiviral drug, [[pleconaril]], that targets [[Picornaviridae|picornaviruses]], the viruses that cause the majority of common colds. [[Pleconaril]] has been shown to be effective in an [[Route of administration|oral]] form.<ref>{{cite journal
[[ViroPharma]] and [[Schering-Plough]] are developing an antiviral drug, [[pleconaril]], that targets [[Picornaviridae|picornaviruses]], the viruses that cause the majority of common colds. [[Pleconaril]] has been shown to be effective in an [[Route of administration|oral]] form.<ref>{{cite journal
  | last = Pevear
  | last = Pevear
  | first = Daniel C.
  | first = Daniel C.
Line 49: Line 48:
  | pages = 1185
  | pages = 1185
}}</ref>
}}</ref>
[[Schering-Plough]] is developing an [[Route of administration|intra-nasal]] formulation that may have fewer adverse effects.<ref name="CTgov">{{cite web
* [[Schering-Plough]] is developing an [[Route of administration|intra-nasal]] formulation that may have fewer adverse effects.<ref name="CTgov">{{cite web
| url = http://www.clinicaltrials.gov/ct/gui/show/NCT00394914
| url = http://www.clinicaltrials.gov/ct/gui/show/NCT00394914
| title = Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2)
| title = Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2)
Line 61: Line 60:
There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.
There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.
*[[analgesic]]s such as [[aspirin]] or [[paracetamol]] (acetaminophen), as well as localised versions targeting the throat (often delivered in [[lozenge]] form)
*[[analgesic]]s such as [[aspirin]] or [[paracetamol]] (acetaminophen), as well as localised versions targeting the throat (often delivered in [[lozenge]] form)
*nasal decongestants such as [[pseudoephedrine]] or [[oxymetazoline]] which reduce the inflammation in the nasal passages by constricting local blood vessels
*Nasal decongestants such as [[pseudoephedrine]] or [[oxymetazoline]] which reduce the inflammation in the nasal passages by constricting local blood vessels
*[[cough medicine|cough suppressants]] such as [[dextromethorphan]] which suppress the cough reflex.
*[[cough medicine|Cough suppressants]] such as [[dextromethorphan]] which suppress the cough reflex.
*first-generation [[anti-histamine]]s such as [[brompheniramine]], [[chlorpheniramine]], [[diphenhydramine]] and [[clemastine]] (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation antihistamines do not have a useful effect on colds.
*First-generation [[anti-histamine]]s such as [[brompheniramine]], [[chlorpheniramine]], [[diphenhydramine]] and [[clemastine]] (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation antihistamines do not have a useful effect on colds.


===Other===
===Other===
====Vitamin C====
====Vitamin C====
A well known supporter of the theory that [[Vitamin C megadosage]] prevented infection was Nobel Prize winner [[Linus Pauling]],<ref>{{cite web|url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=389499&pageindex=1#page|title=Pauling L, The Significance of the Evidence about Ascorbic Acid and the Common Cold, Proc Natl Acad Sci U S A. 1971 November; 68(11): 2678–2681.}}</ref> who wrote the bestseller ''Vitamin C and the Common Cold''.<ref name="isbn0-7167-0159-6">{{cite book | author = Pauling, Linus | title = Vitamin C and the common cold | publisher = W. H. Freeman | location = San Francisco | year = 1970 | pages = | isbn = 0-7167-0159-6 | oclc = | doi = }}</ref> A [[meta-analysis]] published in 2005 found that "the lack of effect of prophylactic vitamin C supplementation on the incidence of common cold in normal populations throws doubt on the utility of this wide practice".<ref name="pmid15971944">{{cite journal | author = Douglas RM, Hemilä H | title = Vitamin C for preventing and treating the common cold | journal = PLoS Med. | volume = 2 | issue = 6 | year = 2005 | pmid = 15971944 | doi = 10.1371/journal.pmed.0020168}}</ref>
* A well known supporter of the theory that [[Vitamin C megadosage]] prevented infection was Nobel Prize winner [[Linus Pauling]],<ref>{{cite web|url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=389499&pageindex=1#page|title=Pauling L, The Significance of the Evidence about Ascorbic Acid and the Common Cold, Proc Natl Acad Sci U S A. 1971 November; 68(11): 2678–2681.}}</ref> who wrote the bestseller ''Vitamin C and the Common Cold''.<ref name="isbn0-7167-0159-6">{{cite book | author = Pauling, Linus | title = Vitamin C and the common cold | publisher = W. H. Freeman | location = San Francisco | year = 1970 | pages = | isbn = 0-7167-0159-6 | oclc = | doi = }}</ref>  
 
* A [[meta-analysis]] published in 2005 found that "the lack of effect of prophylactic vitamin C supplementation on the incidence of common cold in normal populations throws doubt on the utility of this wide practice".<ref name="pmid15971944">{{cite journal | author = Douglas RM, Hemilä H | title = Vitamin C for preventing and treating the common cold | journal = PLoS Med. | volume = 2 | issue = 6 | year = 2005 | pmid = 15971944 | doi = 10.1371/journal.pmed.0020168}}</ref>
A follow-up meta-analysis supported these conclusions: <blockquote>[[Prophylaxis|Prophylactic use]] "...of vitamin C has no effect on common cold incidence&nbsp;... [but] reduces the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Therapeutic trials of high doses of vitamin C&nbsp;... starting after the onset of symptoms, showed no consistent effect on either duration or severity of symptoms.&nbsp;... More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials."<ref name="pmid17636648">{{cite journal | author = Douglas R, Hemilä H, Chalker E, Treacy B | title = Vitamin C for preventing and treating the common cold | journal = Cochrane Database of Systematic Reviews (Online) | volume = | issue = 3 | pages = CD000980 | year = 2007 | pmid = 17636648 | doi = 10.1002/14651858.CD000980.pub3 | url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000980/frame.html}}</ref><ref>{{cite news | title = Vitamin C 'does not stop colds' | publisher = BBC | date = 2007-07-18 | url = http://news.bbc.co.uk/2/hi/health/6901405.stm}}</ref></blockquote>
* A follow-up meta-analysis supported these conclusions:  
 
** [[Prophylaxis|Prophylactic use]] "..of vitamin C has no effect on common cold incidence&nbsp;... [but] reduces the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Therapeutic trials of high doses of vitamin C&nbsp;... starting after the onset of symptoms, showed no consistent effect on either duration or severity of symptoms.&nbsp;... More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials."<ref name="pmid17636648">{{cite journal | author = Douglas R, Hemilä H, Chalker E, Treacy B | title = Vitamin C for preventing and treating the common cold | journal = Cochrane Database of Systematic Reviews (Online) | volume = | issue = 3 | pages = CD000980 | year = 2007 | pmid = 17636648 | doi = 10.1002/14651858.CD000980.pub3 | url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000980/frame.html}}</ref><ref>{{cite news | title = Vitamin C 'does not stop colds' | publisher = BBC | date = 2007-07-18 | url = http://news.bbc.co.uk/2/hi/health/6901405.stm}}</ref>  
Most of the studies showing little or no effect employ doses of ascorbate such as 100&nbsp; mg to 500&nbsp; mg per day, considered "small" by vitamin C advocates. Equally important, the plasma half-life of high dose ascorbate above the baseline, controlled by renal resorption, is approximately 30 minutes,<ref>{{cite web|url=http://www.annals.org/cgi/content/full/140/7/533|title=Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7.}}</ref><ref>{{cite web|url=http://www.prweb.com/releases/2004/7/prweb139053.htm|title=Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004}}</ref> which implies that most high dose studies have been methodologically defective and would be expected to show a minimum benefit. Clinical studies of divided dose supplementation, predicted on pharmacological grounds to be effective, have only rarely been reported in the literature.
* Most of the studies showing little or no effect employ doses of ascorbate such as 100&nbsp; mg to 500&nbsp; mg per day, considered "small" by vitamin C advocates. Equally important, the plasma half-life of high dose ascorbate above the baseline, controlled by renal resorption, is approximately 30 minutes,<ref>{{cite web|url=http://www.annals.org/cgi/content/full/140/7/533|title=Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7.}}</ref><ref>{{cite web|url=http://www.prweb.com/releases/2004/7/prweb139053.htm|title=Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004}}</ref> which implies that most high dose studies have been methodologically defective and would be expected to show a minimum benefit. Clinical studies of divided dose supplementation, predicted on pharmacological grounds to be effective, have only rarely been reported in the literature.


====Zinc Preparations====
====Zinc Preparations====
[[Zinc]] is an essential element, necessary for sustaining life. Recommended daily intake has been established and results of zinc deficiency and toxicity have been well characterized.
* [[Zinc]] is an essential element, necessary for sustaining life. Recommended daily intake has been established and results of zinc deficiency and toxicity have been well characterized.
 
* [[Zinc acetate]] and [[zinc gluconate]] have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.<ref name="eby-1984">{{cite journal | author=Eby GA, Davis DR, Halcomb WW | title=Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study | journal=Antimicrob Agents Chemother | year=1984 | pages=20-4 | volume=25 | issue=1 | id = PMID 6367635}}</ref><ref>{{cite journal | last = Macknin | first = ML | coauthors = | date = | year = 1999 | month = January | title = Zinc lozenges for the common cold | journal = Cleve Clin J Med | volume = 66 | issue = 1 | pages = 27-32 | pmid = 9926628}}</ref>
[[Zinc acetate]] and [[zinc gluconate]] have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.<ref name="eby-1984">{{cite journal | author=Eby GA, Davis DR, Halcomb WW | title=Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study | journal=Antimicrob Agents Chemother | year=1984 | pages=20-4 | volume=25 | issue=1 | id = PMID 6367635}}</ref><ref>{{cite journal | last = Macknin | first = ML | coauthors = | date = | year = 1999 | month = January | title = Zinc lozenges for the common cold | journal = Cleve Clin J Med | volume = 66 | issue = 1 | pages = 27-32 | pmid = 9926628}}</ref> Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.<ref>{{cite journal | author = Jeffrey L. Jackson, Emil Lesho and Cecily Peterson | title = Zinc and the Common Cold: A Meta-Analysis Revisited | journal = Journal of Nutrition | year = 2000 | pages = 1512-15 | volume = 130 | issue = Supplement | pmid = | url = http://jn.nutrition.org/cgi/content/full/130/5/1512S}}</ref><ref>{{cite journal | last = Hulisz | first = D | year = 2003 | title = Efficacy of zinc against common cold viruses: an overview | journal = J Am Pharm Assoc | volume = 44 | issue = 5 | pages = 594-603 | pmid = 15496046}}</ref><ref name="jackson-1997">{{cite journal | author=Jackson JL, Peterson C, Lesho E | title=A meta-analysis of zinc salts lozenges and the common cold | journal=Arch Intern Med | year=1997 | pages=2373-6 | volume=157 | issue=20 | id=PMID 9361579 | url=http://archinte.ama-assn.org/cgi/content/abstract/157/20/2373}}</ref> Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.<ref name="MedLinePlus_Zinc">
* Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.<ref>{{cite journal | author = Jeffrey L. Jackson, Emil Lesho and Cecily Peterson | title = Zinc and the Common Cold: A Meta-Analysis Revisited | journal = Journal of Nutrition | year = 2000 | pages = 1512-15 | volume = 130 | issue = Supplement | pmid = | url = http://jn.nutrition.org/cgi/content/full/130/5/1512S}}</ref><ref>{{cite journal | last = Hulisz | first = D | year = 2003 | title = Efficacy of zinc against common cold viruses: an overview | journal = J Am Pharm Assoc | volume = 44 | issue = 5 | pages = 594-603 | pmid = 15496046}}</ref><ref name="jackson-1997">{{cite journal | author=Jackson JL, Peterson C, Lesho E | title=A meta-analysis of zinc salts lozenges and the common cold | journal=Arch Intern Med | year=1997 | pages=2373-6 | volume=157 | issue=20 | id=PMID 9361579 | url=http://archinte.ama-assn.org/cgi/content/abstract/157/20/2373}}</ref>  
{{cite web | url = http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-zinc.html | title = MedlinePlus Herbs and Supplements: Zinc}}</ref> The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids ([[citric acid]], [[ascorbic acid]] and [[glycine]]) present in the lozenge.<ref name="eby-2004">{{cite journal | author=Eby GA | title=Zinc lozenges: cold cure or candy? Solution chemistry determinations | journal=Biosci Rep | year=2004 | pages=23-39 | volume=24 | issue=1 | id=PMID 15499830}}</ref> Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.<ref>{{cite journal | last = Eby | first = George | coauthors = Halcomb WW | year = 2006 | title = Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial | journal = Altern Ther Health Med | volume = 12 | issue = 1 | pages = 34-38 | pmid = 16454145}}</ref><ref>{{cite web | url = http://www.uspharmacist.com/oldformat.asp?url=newlook/files/alte/feat2.htm | title = Zinc and the Common Cold: What Pharmacists Need to Know | author = Darrell T. Hulisz}}</ref>
* Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.<ref name="MedLinePlus_Zinc">{{cite web | url = http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-zinc.html | title = MedlinePlus Herbs and Supplements: Zinc}}</ref>  
* The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids ([[citric acid]], [[ascorbic acid]] and [[glycine]]) present in the lozenge.<ref name="eby-2004">{{cite journal | author=Eby GA | title=Zinc lozenges: cold cure or candy? Solution chemistry determinations | journal=Biosci Rep | year=2004 | pages=23-39 | volume=24 | issue=1 | id=PMID 15499830}}</ref> Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.<ref>{{cite journal | last = Eby | first = George | coauthors = Halcomb WW | year = 2006 | title = Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial | journal = Altern Ther Health Med | volume = 12 | issue = 1 | pages = 34-38 | pmid = 16454145}}</ref><ref>{{cite web | url = http://www.uspharmacist.com/oldformat.asp?url=newlook/files/alte/feat2.htm | title = Zinc and the Common Cold: What Pharmacists Need to Know | author = Darrell T. Hulisz}}</ref>


There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are [[haemochromatosis]] [[heterozygote]]s.<ref name="barton-1997">{{cite journal | author=Barton JC, Bertoli LF | title=Zinc gluconate lozenges for treating the common cold | journal=Ann Intern Med | year=1997 | pages=738-9 | volume=126 | issue=9 | id=PMID 9139564}}</ref> Use of high doses of zinc for more than two weeks may cause [[copper]] depletion, which leads to [[anemia]].<ref name = "PDRZinc">{{cite web | title = Zinc | work = PDRhealth | publisher = Thomson Healthcare | url = http://www.pdrhealth.com/drugs/altmed/altmed-mono.aspx?contentFileName=ame0182.xml&contentName=Zinc&contentId=345}}</ref> Other adverse events of high doses of zinc include [[nausea]], [[emesis|vomiting]] gastrointestinal discomfort, [[headache]], [[drowsiness]], unpleasant taste, taste distortion, abdominal cramping, and [[diarrhea]].<ref name="MedLinePlus_Zinc"/><ref name="PDRZinc"/> Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of [[smell]].<ref name = WashPostZinc">{{cite news | title = Paying Through the Nose: Maker of Cold Spray Settles Lawsuits for $12 Million but Denies Claim That Zinc Product Ruined Users' Sense of Smell | author = Sandra G. Boodman | publisher = The Washington Post | url = http://www.washingtonpost.com/wp-dyn/content/article/2006/01/30/AR2006013001240.html}}</ref>
* There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are [[haemochromatosis]] [[heterozygote]]s.<ref name="barton-1997">{{cite journal | author=Barton JC, Bertoli LF | title=Zinc gluconate lozenges for treating the common cold | journal=Ann Intern Med | year=1997 | pages=738-9 | volume=126 | issue=9 | id=PMID 9139564}}</ref> Use of high doses of zinc for more than two weeks may cause [[copper]] depletion, which leads to [[anemia]].<ref name="PDRZinc">{{cite web | title = Zinc | work = PDRhealth | publisher = Thomson Healthcare | url = http://www.pdrhealth.com/drugs/altmed/altmed-mono.aspx?contentFileName=ame0182.xml&contentName=Zinc&contentId=345}}</ref>
* Other adverse events of high doses of zinc include [[nausea]], [[emesis|vomiting]] gastrointestinal discomfort, [[headache]], [[drowsiness]], unpleasant taste, taste distortion, abdominal cramping, and [[diarrhea]].<ref name="MedLinePlus_Zinc" /><ref name="PDRZinc" />
* Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of [[smell]].<ref name="WashPostZinc&quot;">{{cite news | title = Paying Through the Nose: Maker of Cold Spray Settles Lawsuits for $12 Million but Denies Claim That Zinc Product Ruined Users' Sense of Smell | author = Sandra G. Boodman | publisher = The Washington Post | url = http://www.washingtonpost.com/wp-dyn/content/article/2006/01/30/AR2006013001240.html}}</ref>


Although widely available and advertised in the United States as dietary supplements or homeopathic treatments, the safety and efficacy of zinc preparations have not been evaluated or approved by the [[Food and Drug Administration]]. Authoritative sources consider the effect of zinc preparations on the cold unproven.{{see also|Zinc gluconate}}
* Although widely available and advertised in the United States as dietary supplements or homeopathic treatments, the safety and efficacy of zinc preparations have not been evaluated or approved by the [[Food and Drug Administration]]. Authoritative sources consider the effect of zinc preparations on the cold unproven.


====Steam Inhalation====
====Steam Inhalation====
Many people believe that steam inhalation reduces symptoms of the cold.<ref name="pmid10718693">{{cite journal
* Many people believe that steam inhalation reduces symptoms of the cold.<ref name="pmid10718693">{{cite journal
| author = Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R
| author = Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R
| title = Patient beliefs about the characteristics, causes, and care of the common cold: an update
| title = Patient beliefs about the characteristics, causes, and care of the common cold: an update
Line 95: Line 97:
| doi =
| doi =
}}</ref>
}}</ref>
 
* However, a [[double-blind]], placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.<ref>{{cite journal
However, a [[double-blind]], placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.<ref>{{cite journal
  | last = Forstall
  | last = Forstall
  | first = G. J.
  | first = G. J.
Line 106: Line 107:
  | issue = 14
  | issue = 14
  | url = http://jama.ama-assn.org/cgi/content/abstract/271/14/1109
  | url = http://jama.ama-assn.org/cgi/content/abstract/271/14/1109
  }}</ref> A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment."<ref>{{cite journal
  }}</ref>  
* A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment."<ref>{{cite journal
  | last = Singh
  | last = Singh
  | first = M
  | first = M
Line 114: Line 116:
  | issue = 2
  | issue = 2
  | url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/rel0002/CD001728/frame.html
  | url = http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/rel0002/CD001728/frame.html
}}</ref> There have been reports of children being badly burned when using steam inhalation to alleviate cold symptoms leading to the recommendation to "...start discouraging patients from using this form of home remedy, as there appears to be no significant benefit from steam inhalation."<ref>{{cite journal
}}</ref>
* There have been reports of children being badly burned when using steam inhalation to alleviate cold symptoms leading to the recommendation to "...start discouraging patients from using this form of home remedy, as there appears to be no significant benefit from steam inhalation."<ref>{{cite journal
  | quotes =
  | quotes =
  | author = MA Akhavani
  | author = MA Akhavani
Line 124: Line 127:
  | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472796
  | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472796
}}</ref>
}}</ref>
* '''Rhinovirus treatment (commom cold)'''
:* '''Supportive therapy'''
::* 1. Symptomatic treatment-[[Ipratropium bromide]] intranasal (2 sprays tid) {{and}} [[Clemastine]] 1.34 mg 1–2 tab PO bid–tid (over the counter)
::* 2. Symptomatic relief by [[Ipratropium]] nasal spray decreases rhinorrhea and sneezing vs placebo.<ref name="pmid9880472">{{cite journal| author=Gern JE, Busse WW| title=Association of rhinovirus infections with asthma. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 1 | pages= 9-18 | pmid=9880472 | doi= | pmc=PMC88904 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9880472}}</ref> {{and}} [[Clemastine]] (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.<ref name="pmid8729205">{{cite journal| author=Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB| title=Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 4 | pages= 656-62 | pmid=8729205 | doi= | pmc= url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205  }}</ref>{{or}} Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).<ref name="pmid12802751">{{cite journal| author=Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA et al.| title=Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1523-32 | pmid=12802751 | doi=10.1086/375069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802751  }} </ref>
:::* Note (1): No antiviral treatment indicated.<ref name="pmid15693216">{{cite journal| author=Turner RB| title=New considerations in the treatment and prevention of rhinovirus infections. | journal=Pediatr Ann | year= 2005 | volume= 34 | issue= 1 | pages= 53-7 | pmid=15693216 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15693216  }} </ref>
:::* Note (2): Found in half of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004).<ref name="pmid12517470">{{cite journal| author=Heikkinen T, Järvinen A| title=The common cold. | journal=Lancet | year= 2003 | volume= 361 | issue= 9351 | pages= 51-9 | pmid=12517470 | doi=10.1016/S0140-6736(03)12162-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517470  }} </ref>
:::* Note (3): High rate of rhinovirus identified in children with significant lower resp tract infections.<ref name="pmid19258921">{{cite journal| author=Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T et al.| title=Rhinovirus associated with severe lower respiratory tract infections in children. | journal=Pediatr Infect Dis J | year= 2009 | volume= 28 | issue= 4 | pages= 337-9 | pmid=19258921 | doi=10.1097/INF.0b013e31818ffc1b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19258921  }} </ref>


==References==
==References==

Revision as of 13:24, 25 June 2017

Acute viral nasopharyngitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating acute viral nasopharyngitis from other diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

CT

MRI

Ultrasound

Other imaging findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute viral nasopharyngitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute viral nasopharyngitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Acute viral nasopharyngitis medical therapy

CDC on Acute viral nasopharyngitis medical therapy

Acute viral nasopharyngitis medical therapy in the news

Blogs onAcute viral nasopharyngitis medical therapy

Directions to Hospitals Treating Osteoporosis

Risk calculators and risk factors for Acute viral nasopharyngitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

As there is no medically proven and accepted medication directly targeting the causative agent, there is no cure for the common cold. Treatment is limited to symptomatic supportive options, maximizing the comfort of the patient, and limiting complications and harmful sequelae. The most reliable treatment is a combination of fluids and plenty of rest.

Medical Therapy

The common cold is self-limiting, and the host's immune system effectively deals with the infection. Within a few days, the body's humoral immune response begins producing specific antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated immune response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average.

Palliative Care

Antibiotics

  • Antibiotics do not have any beneficial effect against the common cold.
  • Their use in cases of common cold infection is ineffective and may contribute to antibiotic resistance of bacteria present in the patient's body.

Antivirals

Over-the-counter Symptom Medicines

There are a number of effective treatments which, rather than treat the viral infection, focus on relieving the symptoms. For some people, colds are relatively minor inconveniences and they can go on with their daily activities with tolerable discomfort. This discomfort has to be weighed against the price and possible side effects of the remedies.

Other

Vitamin C

  • A well known supporter of the theory that Vitamin C megadosage prevented infection was Nobel Prize winner Linus Pauling,[5] who wrote the bestseller Vitamin C and the Common Cold.[6]
  • A meta-analysis published in 2005 found that "the lack of effect of prophylactic vitamin C supplementation on the incidence of common cold in normal populations throws doubt on the utility of this wide practice".[7]
  • A follow-up meta-analysis supported these conclusions:
    • Prophylactic use "..of vitamin C has no effect on common cold incidence ... [but] reduces the duration and severity of common cold symptoms slightly, although the magnitude of the effect was so small its clinical usefulness is doubtful. Therapeutic trials of high doses of vitamin C ... starting after the onset of symptoms, showed no consistent effect on either duration or severity of symptoms. ... More therapeutic trials are necessary to settle the question, especially in children who have not entered these trials."[8][9]
  • Most of the studies showing little or no effect employ doses of ascorbate such as 100  mg to 500  mg per day, considered "small" by vitamin C advocates. Equally important, the plasma half-life of high dose ascorbate above the baseline, controlled by renal resorption, is approximately 30 minutes,[10][11] which implies that most high dose studies have been methodologically defective and would be expected to show a minimum benefit. Clinical studies of divided dose supplementation, predicted on pharmacological grounds to be effective, have only rarely been reported in the literature.

Zinc Preparations

  • Zinc is an essential element, necessary for sustaining life. Recommended daily intake has been established and results of zinc deficiency and toxicity have been well characterized.
  • Zinc acetate and zinc gluconate have been tested as potential treatments for the common cold, in various dosage form including nasal sprays, nasal gels, and lozenges.[12][13]
  • Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.[14][15][16]
  • Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.[17]
  • The studies differ in the salt used, concentration of the salt, dosage form, and formulation, and some suffer from defects in design or methods. For example, there is evidence that the potential efficacy of zinc gluconate lozenges may be affected by other food acids (citric acid, ascorbic acid and glycine) present in the lozenge.[18] Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.[19][20]
  • There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are haemochromatosis heterozygotes.[21] Use of high doses of zinc for more than two weeks may cause copper depletion, which leads to anemia.[22]
  • Other adverse events of high doses of zinc include nausea, vomiting gastrointestinal discomfort, headache, drowsiness, unpleasant taste, taste distortion, abdominal cramping, and diarrhea.[17][22]
  • Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of smell.[23]
  • Although widely available and advertised in the United States as dietary supplements or homeopathic treatments, the safety and efficacy of zinc preparations have not been evaluated or approved by the Food and Drug Administration. Authoritative sources consider the effect of zinc preparations on the cold unproven.

Steam Inhalation

  • Many people believe that steam inhalation reduces symptoms of the cold.[24]
  • However, a double-blind, placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.[25]
  • A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment."[26]
  • There have been reports of children being badly burned when using steam inhalation to alleviate cold symptoms leading to the recommendation to "...start discouraging patients from using this form of home remedy, as there appears to be no significant benefit from steam inhalation."[27]

References

  1. ↑ "Common Cold". PDRHealth. Thomson Healthcare.
  2. ↑ Pevear, Daniel C. (1999). "Activity of Pleconaril against Enteroviruses". Antimicrobial Agents and Chemotherapy. 43 (9): 2109–2115. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  3. ↑ McConnell, J. (2 October, 1999). "Enteroviruses succumb to new drug". The Lancet. 354 (9185): 1185. Check date values in: |date= (help)
  4. ↑ "Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2)". ClinicalTrials.gov. U.S. National Institutes of Health. 2007. Unknown parameter |month= ignored (help)
  5. ↑ "Pauling L, The Significance of the Evidence about Ascorbic Acid and the Common Cold, Proc Natl Acad Sci U S A. 1971 November; 68(11): 2678–2681".
  6. ↑ Pauling, Linus (1970). Vitamin C and the common cold. San Francisco: W. H. Freeman. ISBN 0-7167-0159-6.
  7. ↑ Douglas RM, Hemilä H (2005). "Vitamin C for preventing and treating the common cold". PLoS Med. 2 (6). doi:10.1371/journal.pmed.0020168. PMID 15971944.
  8. ↑ Douglas R, Hemilä H, Chalker E, Treacy B (2007). "Vitamin C for preventing and treating the common cold". Cochrane Database of Systematic Reviews (Online) (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.
  9. ↑ "Vitamin C 'does not stop colds'". BBC. 2007-07-18.
  10. ↑ "Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7".
  11. ↑ "Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004".
  12. ↑ Eby GA, Davis DR, Halcomb WW (1984). "Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study". Antimicrob Agents Chemother. 25 (1): 20–4. PMID 6367635.
  13. ↑ Macknin, ML (1999). "Zinc lozenges for the common cold". Cleve Clin J Med. 66 (1): 27–32. PMID 9926628. Unknown parameter |month= ignored (help)
  14. ↑ Jeffrey L. Jackson, Emil Lesho and Cecily Peterson (2000). "Zinc and the Common Cold: A Meta-Analysis Revisited". Journal of Nutrition. 130 (Supplement): 1512–15.
  15. ↑ Hulisz, D (2003). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc. 44 (5): 594–603. PMID 15496046.
  16. ↑ Jackson JL, Peterson C, Lesho E (1997). "A meta-analysis of zinc salts lozenges and the common cold". Arch Intern Med. 157 (20): 2373–6. PMID 9361579.
  17. ↑ 17.0 17.1 "MedlinePlus Herbs and Supplements: Zinc".
  18. ↑ Eby GA (2004). "Zinc lozenges: cold cure or candy? Solution chemistry determinations". Biosci Rep. 24 (1): 23–39. PMID 15499830.
  19. ↑ Eby, George (2006). "Ineffectiveness of zinc gluconate nasal spray and zinc orotate lozenges in common-cold treatment: a double-blind, placebo-controlled clinical trial". Altern Ther Health Med. 12 (1): 34–38. PMID 16454145. Unknown parameter |coauthors= ignored (help)
  20. ↑ Darrell T. Hulisz. "Zinc and the Common Cold: What Pharmacists Need to Know".
  21. ↑ Barton JC, Bertoli LF (1997). "Zinc gluconate lozenges for treating the common cold". Ann Intern Med. 126 (9): 738–9. PMID 9139564.
  22. ↑ 22.0 22.1 "Zinc". PDRhealth. Thomson Healthcare.
  23. ↑ Sandra G. Boodman. "Paying Through the Nose: Maker of Cold Spray Settles Lawsuits for $12 Million but Denies Claim That Zinc Product Ruined Users' Sense of Smell". The Washington Post.
  24. ↑ Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R (2000). "Patient beliefs about the characteristics, causes, and care of the common cold: an update". The Journal of Family Practice. 49 (2): 153–6. PMID 10718693.
  25. ↑ Forstall, G. J. (13 April, 1994). "Effect of inhaling heated vapor on symptoms of the common cold". Journal of the American Medical Association (JAMA). 271 (14). Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  26. ↑ Singh, M (19 April, 2004). "Heated, humidified air for the common cold". The Cochrane Database of Systematic Reviews (2). Check date values in: |date= (help)
  27. ↑ MA Akhavani (1 July, 2005). "Steam inhalation treatment for children". British Journal of General Practice. 55. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Acute_viral_nasopharyngitis_medical_therapy&oldid=1320714"