Acute viral nasopharyngitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

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 pain or cold medicines. Saline nasal drops may help alleviate congestion.

The American Lung Association recommends avoiding coffee, tea or cola drinks that contain caffeine and avoiding alcoholic beverages. Both caffeine and alcohol cause dehydration.

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

There are no approved antiviral drugs for the common cold.

ViroPharma and Schering-Plough are developing an antiviral drug, pleconaril, that targets picornaviruses, the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in an oral form. Schering-Plough is developing an intra-nasal formulation that may have fewer adverse effects.

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.

• analgesics 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
• cough suppressants such as dextromethorphan which suppress the cough reflex.
• first-generation anti-histamines 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 anti-histamines do not have a useful effect on colds.

Other

Vitamin C

A well known supporter of the theory that Vitamin C megadosage prevented infection was Nobel Prize winner Linus Pauling, who wrote the bestseller Vitamin C and the Common Cold. 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".

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."

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, 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. Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse. Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action. 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. Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.

There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are haemochromatosis heterozygotes. Use of high doses of zinc for more than two weeks may cause copper depletion, which leads to anemia. Other adverse events of high doses of zinc include nausea, vomiting gastrointestinal discomfort, headache, drowsiness, unpleasant taste, taste distortion, abdominal cramping, and diarrhea. Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of smell.

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

Steam Inhalation

Many people believe that steam inhalation reduces symptoms of the cold.

However, a double-blind, placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms. A scientific review of medical literature concluded that "there is insufficient evidence to support the use of steam inhalation as a treatment." 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."