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 using palliative measures like fluids, rest and throat sprays. Analgesics, nasal decongestants and cough suppressants can be used to alleviate the symptoms. Antibiotics have no use in common cold as the disease is viral in origin and there is no approved antiviral drug for the common cold. Mega doses of vitamin C, Zinc and steam inhalation are not proved to be of benefit in treating common cold despite the wide belief of their use.

Medical Therapy

The 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 including plenty of fluids, rest, and throat sprays help in alleviating congestion and easing symptoms.
• Alcohol and caffeine-containing beverages should be avoided, as they cause dehydration.

Antibiotics

• Antibiotics have no use in common cold as the disease is viral in origin.
• Haphazard use of antibiotics can cause development of resistant bacterial strains and spread of antibiotic resistance.

Antivirals

• There is no approved antiviral drug for the common cold.
• ViroPharma and Schering-Plough are developing an antiviral drug called pleconaril that targets picornaviruses and the viruses that cause the majority of common colds. Pleconaril has been shown to be effective in oral form.
• Schering-Plough is developing an intranasal formulation that may have fewer adverse effects.

Over-the-counter (OTC) symptom reliever medicines

There are a number of effective treatments that focus on relieving the symptoms rather than treating the viral infection. 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.

Some of the symptom relieving OTCs include the following:

• Analgesics such as aspirin or paracetamol (i.e. acetaminophen).
• Nasal decongestants such as pseudoephedrine or oxymetazoline, which reduce congestion 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, or clemastine, which combat congested/runny noses by reducing mucus secretion, but may make the patient 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 could prevent 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 "lack of prophylactic vitamin C supplementation effect on the incidence of common cold in normal population, throws doubt on the utility of this wide practice."
• A follow-up meta-analysis supported conclusions including:
  • Prophylactic use "...of vitamin C has no effect on common cold incidence... [but] it reduces the duration and severity of common cold symptoms slightly; however, 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 included in these trials."
• Most of the studies showed little or no effect in employing ascorbate doses between 100-500 mg/day, which is considered "small" by vitamin C advocates. Equally important, the plasma half-life of high-dose ascorbate, 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 rarely been reported in literature.

Zinc preparations

• Zinc is an essential element necessary for sustaining life. Recommended daily intake has been established; 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 forms, including nasal sprays, nasal gels, and lozenges.
• Some studies have shown an effect of zinc preparations on duration of the common cold, but conclusions are diverse.
• Approximately half of studies demonstrate efficacy. Studies that show clinical effects have not demonstrated the mechanism of action.
• The studies differ in type, concentration, dosage form, and formulation of the used salt; 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 edible acids present in the lozenge (e.g. citric acid, ascorbic acid, and glycine). Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.

• There are concerns regarding the safety of cold preparations' long-term use in the estimated 25 million persons who are hemochromatosis heterozygotes. Use of high doses of zinc for more than two weeks may cause copper depletion, which leads to anemia.
• Other adverse events related to high doses of zinc include nausea, vomiting, gastrointestinal discomfort, headache, drowsiness, unpleasant taste, taste distortion, abdominal cramping, and diarrhea.
• Some users of zinc administered through a nasal spray applicator have reported temporary or permanent loss of their 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 common cold unproven.

Steam inhalation

• Many people believe that steam inhalation reduces symptoms of the cold.
• In a randomized, double blinded, controlled trial, steam inhalation was not effective in alleviating cold symptoms.
• Many cases of burns during steam inhalation have been reported in children.