Acute viral nasopharyngitis medical therapy: Difference between revisions

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__NOTOC__
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{{Acute viral nasopharyngitis(common cold)}}
{{Acute viral nasopharyngitis(common cold)}}
{{CMG}}
{{CMG}};{{AE}}{{AY}}


==Overview==
==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.
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 suppressant|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==
==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.
The common cold is a [[self-limiting]] disease even without treatment. Both [[Humoral immunity|humoral]] and [[cell-mediated immunity]] are capable of clearing the virus in seven days.


===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
* Palliative measures including plenty of fluids, rest, and throat sprays help in alleviating [[congestion]] and easing symptoms.
| title = Common Cold
* [[Alcohol]] and caffeine-containing beverages should be avoided, as they cause [[dehydration]].
| work = PDRHealth
| publisher = Thomson Healthcare
| url = http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=BHG01ID25.xml&contentName=Common+Cold&contentId=30
}}</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]].


===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]] have no use in common cold as the disease is viral in origin.
* Haphazard use of [[antibiotics]] can cause development of [[Drug resistance|resistant]] [[strains|bacterial strains]] and spread of [[antibiotic resistance]].


===Antivirals===
===Antivirals===
There are no approved [[antiviral drug]]s for the common cold.
* There is no approved [[antiviral drug]] for the common cold.
 
* [[ViroPharma]] and Schering-Plough are developing an [[antiviral drug]] called [[pleconaril]] that targets [[Picornaviridae|picornaviruses]] and the [[Virus|viruses]] that cause the majority of common colds. [[Pleconaril]] has been shown to be effective in [[Route of administration|oral]] form.<ref name="pmid10471549">{{cite journal| author=Pevear DC, Tull TM, Seipel ME, Groarke JM| title=Activity of pleconaril against enteroviruses. | journal=Antimicrob Agents Chemother | year= 1999 | volume= 43 | issue= 9 | pages= 2109-15 | pmid=10471549 | doi= | pmc=89431 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10471549 }} </ref><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
| first = Daniel C.
| coauthors = Tina M. Tull, Martin E. Seipel, James M. Groarke
| year = 1999
| month = September
| title = Activity of Pleconaril against Enteroviruses
| journal = Antimicrobial Agents and Chemotherapy
| volume = 43
| issue = 9
| pages = 2109-2115
| url = http://aac.asm.org/cgi/content/full/43/9/2109
  | language =
}}</ref><ref>{{cite journal
  | quotes =
  | quotes =
  | last = McConnell
  | last = McConnell
  | first = J.
  | first = J.
  | date = 2 October, 1999
  | date = 2 October 1999
  | title = Enteroviruses succumb to new drug
  | title = Enteroviruses succumb to new drug
  | journal = The Lancet
  | journal = The Lancet
Line 49: Line 30:
  | 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|intranasal]] formulation that may have fewer adverse effects.<ref name="urlEffects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295) - Full Text View - ClinicalTrials.gov">{{cite web |url=https://www.clinicaltrials.gov/ct/gui/show/NCT00394914 |title=Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295) - Full Text View - ClinicalTrials.gov |format= |work= |accessdate=}}</ref>
| 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)
===Over-the-counter (OTC) symptom reliever medicines===
| month = March
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.
| year = 2007
| publisher = U.S. [[National Institutes of Health]]
| work = ClinicalTrials.gov
}}</ref>


===Over-the-counter Symptom Medicines===
Some of the symptom relieving OTCs include the following:
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]] (i.e. [[acetaminophen]]).
*[[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 [[congestion]] 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]], or [[clemastine]], which combat congested/runny noses by reducing mucus secretion, but may make the patient drowsy.  
*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 anti-histamines do not have a useful effect on colds.
*[[Antihistamines|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]] could prevent infection" was [[Nobel Prize]] winner [[Linus Pauling]], who wrote the bestseller ''Vitamin C and the Common Cold''.<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><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 "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."<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 conclusions including:  
 
** [[Prophylaxis|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." 
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.
** [[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."<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 showed little or no effect in employing [[Vitamin C|ascorbate]] doses between 100-500 mg/day, which is considered "small" by [[vitamin C]] advocates. Equally important, the [[Half-life|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.<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>
* Clinical studies of divided-dose supplementation, predicted on pharmacological grounds to be effective, have rarely been reported in 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; 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 spray|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 name="pmid9926628">{{cite journal| author=Macknin ML| title=Zinc lozenges for the common cold. | journal=Cleve Clin J Med | year= 1999 | volume= 66 | issue= 1 | pages= 27-32 | pmid=9926628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9926628  }} </ref>
* Some studies have shown an effect of [[zinc]] preparations on 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. Studies that show clinical effects 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 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]]).<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 name="pmid16454145">{{cite journal| author=Eby GA, Halcomb WW| 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 | year= 2006 | volume= 12 | issue= 1 | pages= 34-8 | pmid=16454145 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=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>


[[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">
* There are concerns regarding the safety of cold preparations' long-term use in the estimated 25 million persons who are [[hemochromatosis]] [[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>
{{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>
* Other adverse events related to high doses of [[Zinc (element)|zinc]] include [[nausea]], [[emesis|vomiting]], [[Gastrointestinal tract|gastrointestinal discomfort]], [[headache]], [[drowsiness]], unpleasant taste, taste distortion, [[abdominal cramping]], and [[diarrhea]].<ref name="MedLinePlus_Zinc" /><ref name="PDRZinc" />
* Some users of [[zinc]] administered through a [[nasal spray]] applicator have reported temporary or permanent loss of their 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>


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>
* 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.


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.<ref name="pmid10718693">{{cite journal
====Steam Inhalation====
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 77:
| doi =
| doi =
}}</ref>
}}</ref>
 
* In a randomized, double blinded, controlled trial, steam inhalation was not effective in alleviating cold symptoms.<ref name="pmid8151854">{{cite journal| author=Forstall GJ, Macknin ML, Yen-Lieberman BR, Medendrop SV| title=Effect of inhaling heated vapor on symptoms of the common cold. | journal=JAMA | year= 1994 | volume= 271 | issue= 14 | pages= 1109-11 | pmid=8151854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8151854  }} </ref>
However, a [[double-blind]], placebo-controlled, randomized study found no effect of steam inhalation on cold symptoms.<ref>{{cite journal
* Many cases of burns during steam inhalation have been reported in children.<ref name="pmid16004753">{{cite journal |vauthors=Akhavani MA, Baker RH |title=Steam inhalation treatment for children |journal=Br J Gen Pract |volume=55 |issue=516 |pages=557 |year=2005 |pmid=16004753 |pmc=1472796 |doi= |url=}}</ref>
| last = Forstall
| first = G. J.
| coauthors = M. L. Macknin, B. R. Yen-Lieberman, S. V. Medendrop
| date = 13 April, 1994
| title = Effect of inhaling heated vapor on symptoms of the common cold
| journal = Journal of the American Medical Association (JAMA)
| volume = 271
| issue = 14
| 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
| last = Singh
| first = M
| date = 19 April, 2004
| title = Heated, humidified air for the common cold
| journal = The Cochrane Database of Systematic Reviews
| issue = 2
| 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
| quotes =
| author = MA Akhavani
| coauthors = RHJ Baker
| date = 1 July, 2005
| title = Steam inhalation treatment for children
| journal = British Journal of General Practice
| volume = 55
| url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472796
}}</ref>


==References==
==References==
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Latest revision as of 20:17, 29 July 2020

Acute viral nasopharyngitis Microchapters

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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

Antivirals

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:

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.[4][5]
  • 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."[6]
  • 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."[7][8]
  • 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.[9][10]
  • 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.[11][12]
  • Some studies have shown an effect of zinc preparations on duration of the common cold, but conclusions are diverse.[13][14][15]
  • Approximately half of studies demonstrate efficacy. Studies that show clinical effects have not demonstrated the mechanism of action.[16]
  • 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).[17] Furthermore, interpretation of the results depends on whether concentration of total zinc or ionic zinc is considered.[18][19]
  • 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.[23]
  • In a randomized, double blinded, controlled trial, steam inhalation was not effective in alleviating cold symptoms.[24]
  • Many cases of burns during steam inhalation have been reported in children.[25]

References

  1. ↑ 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.
  2. ↑ McConnell, J. (2 October 1999). "Enteroviruses succumb to new drug". The Lancet. 354 (9185): 1185.
  3. ↑ "Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295) - Full Text View - ClinicalTrials.gov".
  4. ↑ "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".
  5. ↑ Pauling, Linus (1970). Vitamin C and the common cold. San Francisco: W. H. Freeman. ISBN 0-7167-0159-6.
  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.
  7. ↑ 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.
  8. ↑ "Vitamin C 'does not stop colds'". BBC. 2007-07-18.
  9. ↑ "Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7".
  10. ↑ "Researchers Question Government Recommended Daily Allowance (RDA) for vitamin C, PR Web, July 7, 2004".
  11. ↑ 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.
  12. ↑ Macknin ML (1999). "Zinc lozenges for the common cold". Cleve Clin J Med. 66 (1): 27–32. PMID 9926628.
  13. ↑ 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.
  14. ↑ Hulisz, D (2003). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc. 44 (5): 594–603. PMID 15496046.
  15. ↑ 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. ↑ 16.0 16.1 "MedlinePlus Herbs and Supplements: Zinc".
  17. ↑ Eby GA (2004). "Zinc lozenges: cold cure or candy? Solution chemistry determinations". Biosci Rep. 24 (1): 23–39. PMID 15499830.
  18. ↑ 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.
  19. ↑ Darrell T. Hulisz. "Zinc and the Common Cold: What Pharmacists Need to Know".
  20. ↑ Barton JC, Bertoli LF (1997). "Zinc gluconate lozenges for treating the common cold". Ann Intern Med. 126 (9): 738–9. PMID 9139564.
  21. ↑ 21.0 21.1 "Zinc". PDRhealth. Thomson Healthcare.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ Akhavani MA, Baker RH (2005). "Steam inhalation treatment for children". Br J Gen Pract. 55 (516): 557. PMC 1472796. PMID 16004753.
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