Acute viral nasopharyngitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
The mainstay of therapy for acute viral nasopharyngitis is symptomatic treatment.
Medical Therapy
Common cold is a self-limiting disease even without treatment. Both humoral and cell-mediated immunity are capable of clearing the virus in seven days.
Palliative Care
- Palliative measures as plenty of fluids, rest, and throat sprays help in alleviating the congestion and easing the symptoms.
- Alcohol and caffeine-containing beverages should be avoided as they cause dehydration.
Antibiotics
- The antibiotics have no use in common cold as the disease is viral in origin.
- Haphazard use of antibiotics can cause the development of resistant strains of bacteria and the spread of antibiotic resistance.
Antivirals
- There are no approved antiviral drugs for the common cold.
- ViroPharma and Schering-Plough are developing an antiviral drug, pleconaril that targets picornaviruses and the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in an oral form.[1][2]
- Schering-Plough is developing an intra-nasal formulation that may have fewer adverse effects.[3]
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)
- 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 antihistamines 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,[4] who wrote the bestseller Vitamin C and the Common Cold.[5]
- 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".[6]
- 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 and 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."[7][8]
- 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,[9][10] 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.[11][12]
- Some studies have shown some effect of zinc preparations on the duration of the common cold, but conclusions are diverse.[13][14][15]
- Approximately half of studies demonstrate efficacy. Even studies that show clinical effect have not demonstrated the mechanism of action.[16]
- 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.[17] Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.[18][19]
- There are concerns regarding the safety of long-term use of cold preparations in an estimated 25 million persons who are haemochromatosis heterozygotes.[20] Use of high doses of zinc for more than two weeks may cause copper depletion, which leads to anemia.[21]
- Other adverse events of high doses of zinc include nausea, vomiting, gastrointestinal discomfort, headache, drowsiness, unpleasant taste, taste distortion, abdominal cramping, and diarrhea.[16][21]
- Some users of nasal spray applicators containing zinc have reported temporary or permanent loss of sense of smell.[22]
- 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.[23]
- In a randomized double blinded controlled trial, steam inhalation was not effective in alleviating the symptoms of cold.[24]
- On the other side, many cases of burns during steam inhalation have been reported in children.[25]
References
- ↑ Pevear DC, Tull TM, Seipel ME, Groarke JM (1999). "Activity of pleconaril against enteroviruses". Antimicrob Agents Chemother. 43 (9): 2109–15. PMC 89431. PMID 10471549.
- ↑ McConnell, J. (2 October 1999). "Enteroviruses succumb to new drug". The Lancet. 354 (9185): 1185.
- ↑ "Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295) - Full Text View - ClinicalTrials.gov".
- ↑ "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".
- ↑ Pauling, Linus (1970). Vitamin C and the common cold. San Francisco: W. H. Freeman. ISBN 0-7167-0159-6.
- ↑ 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.
- ↑ 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.
- ↑ "Vitamin C 'does not stop colds'". BBC. 2007-07-18.
- ↑ "Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7".
- ↑ "Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004".
- ↑ 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.
- ↑ Macknin ML (1999). "Zinc lozenges for the common cold". Cleve Clin J Med. 66 (1): 27–32. PMID 9926628.
- ↑ 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.
- ↑ Hulisz, D (2003). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc. 44 (5): 594–603. PMID 15496046.
- ↑ 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.
- ↑ 16.0 16.1 "MedlinePlus Herbs and Supplements: Zinc".
- ↑ Eby GA (2004). "Zinc lozenges: cold cure or candy? Solution chemistry determinations". Biosci Rep. 24 (1): 23–39. PMID 15499830.
- ↑ Eby GA, Halcomb WW (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): 34–8. PMID 16454145.
- ↑ Darrell T. Hulisz. "Zinc and the Common Cold: What Pharmacists Need to Know".
- ↑ Barton JC, Bertoli LF (1997). "Zinc gluconate lozenges for treating the common cold". Ann Intern Med. 126 (9): 738–9. PMID 9139564.
- ↑ 21.0 21.1 "Zinc". PDRhealth. Thomson Healthcare.
- ↑ 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.
- ↑ 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.
- ↑ Forstall GJ, Macknin ML, Yen-Lieberman BR, Medendrop SV (1994). "Effect of inhaling heated vapor on symptoms of the common cold". JAMA. 271 (14): 1109–11. PMID 8151854.
- ↑ Akhavani MA, Baker RH (2005). "Steam inhalation treatment for children". Br J Gen Pract. 55 (516): 557. PMC 1472796. PMID 16004753.