Transcript Common cold 1

Common cold
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Background
Heikkinen T and Järvinen A. Lancet 2003;361:51–59.
• Viral cause : rhinoviruses 30–50%, coronaviruses 10–15%,
influenza viruses 5 – 15%, RSV 5%, parainfluenza viruses 5%
• Youngest children 6 – 8 colds per year, adults 2 – 4
• Seasonality
• Infection transmission :
– Dose-dependant viral “innoculation” load: - hand contact,
direct hit large particle aerosols, lingering small particle
aerosols
– Rhinovirus incubation period 10–12h, influenza 1–7 days
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http://www.idinchildren.com
Source: Gwaltney JM. JAMA. 1967;202:494-498
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To treat a cold?
Cochrane reviews (Arroll B, Kenealy T. Issue 3 2005)
and Clinical Evidence (Arrol B. Search date May 2005)
• Antibiotics: No evidence of benefit, at expense of evidence of
side effects
• Decongestants: Single dose relieves symptoms in adults, no
evidence that repeated use helps. Not recommended in children
• Antihistamines: Inconclusive
• Vitamin C: No evidence that it prevents cold, some evidence, in
high dose that it relieves duration by about 0.5 day.
• Zinc: Inconclusive (harm?)
• Heat, humidified air: Inconclusive – some risks
• Echinacea - Poor quality studies. 3 recent better RCTs all
negative
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Paracetamol or ibuprofen for children?
Arch Pediatr Adolesc Med; 2004; 158: 521 – 526.
• Meta analysis : 17 RCTs in total
• Pain relief (3 RCTs, 186 children) no difference
• Fever reduction favoured ibuprofen (9 RCTs, 1078
children) at 2, 4 and 6 hours
• Safety data showed no difference
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Common cold - Summary
• The common cold is viral in origin and, therefore,
antibiotics are of little benefit at the expense of known
side effects
• Symptoms of the cold can last 2 weeks or more.
Explanation of this and patient reassurance are
important in patient management
• Paracetamol or ibuprofen may be useful to relieve
symptoms of pain
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