The Common Cold: Treatment Algorithms
Source: Virginia Bartok
Relief is available for common cold symptoms.
The cold virus―a human enemy that has been around for centuries―is persistent and annoying. This upper respiratory tract infection is still the same constellation of symptoms―sore throat, nasal congestion, rhinorrhea, cough, fever, and muscle aches and pains1―and to date, no cure exists. Regardless, reviewing the most common treatment algorithms can assist pharmacists in aiding the stream of bleary-eyed, sniffling customers who come to the pharmacy during cold season. Start with a review of the basics in Table 1.1-4
Age Matters
In children and adults, pharmacists usually counsel patients who present with clear symptoms. They should refer patients who have “red flag” symptoms to a physician (Online Table 2).
Symptom relief is the main management strategy, since the common cold is viral and we have no effective treatment. Options include rest, ample hydration, antihistamines, and nasal decongestants.1,5 Patients may need to be reminded to disinfect their environments using phenol-alcohol�Cbased compounds, wash their hands, avoid smoking and alcohol, elevate their heads when sleeping if it helps breathing, and humidify air to soothe nasopharyngeal mucus membranes.1
Kids: Special Concerns
Most patients will want OTC medication for symptoms. Cold and cough medications were among the top 20 substances leading to death in children before 2008, prompting the FDA to require that manufacturers voluntarily relabel these products. Since 2008, these products have had labels that indicate they should not be used in children younger than 4 years. After the labeling change, the number of emergency department (ED) visits related to cough and cold medications (therapeutic errors, unintentional exposures, and adverse drug events) reported in children younger than 2 years halved.6-8 Poison control centers reported decreases in ED visits for older children also.9 An effective alternative to OTC medication for infants with congestion and obstruction is nasal saline drops with bulb-syringe nostril aspiration.1,5
Table 2: The Common Cold: Red Flags Warranting Referral
・ Temperature higher than 100.4°F (30°C)
・ Chest pain or shortness of breath
・ Underlying chronic cardiopulmonary disease
・ Symptoms lasting more than 10 days
・ Age <9 months or frail patients of advanced age
・ Serious symptoms unresponsive to OTC medicines, or new symptoms suggesting complications (eg, otitis media, sinusitis, chronic bronchitis, exacerbations of reactive airway disease)
Adapted from references 1 and 5.
Other Facts
The Online Figure describes treatments and interventions that work. Studies of zinc sulfate show it may decrease symptom duration when it is taken within 24 hours of symptom onset; note that some patients find its taste intolerable and may experience nausea or a loss of taste or smell.10,11
First-generation antihistamines, topical anticholinergics, and ipratropium bromide (available by prescription) reduce rhinorrhea by 25% to 35%.1,12
The Don’ts
No article on colds is complete without a review of ineffective treatments:
• Second-generation (nonsedating) antihistamines are generally ineffective for common cold symptoms.13,14
• Intranasal zinc is not recommended; it can cause permanent damage to sense of smell.15,16
• Echinacea does not appear to reduce a cold’s duration or severity.1,2
• Antibiotics are contraindicated―colds are viral, not bacterial.17
• Codeine does not reduce coughing.18
• Immune-boosting with vitamins and herbs does not seem to prevent colds.19
Endnote
Colds are costly, with patients spending money on treatment, OTC products, and often, useless antibiotics. Colds are also responsible for millions of days of sick leave at work and school. Pharmacists’ best course of action is to help patients self-treat and make rational choices about OTC products when possible and to refer patients when complications are present.
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