Non-steroidal anti-inflammatory drugs for the common cold. It is important to rule out pneumonia. Intranasal ipratropium may decrease rhinorrhea but not congestion related to URIs in children five years and older. Variable (low grade if viral, high if bacterial), Common; mild if viral, severe if bacterial, “The common cold is caused by a virus, so antibiotics won't help.”, “Antibiotics can't fight viruses like colds. Becker LA, 1. ; Hersh AL, Upper respiratory tract infections. Some placebo-controlled trials have found that it is ineffective against some forms of cough, including acute cough in children. 1. Hueston WJ, Ebell MH, Li K, Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Other effective treatments are summarized in Table 5.6,16,41,59–64, Cochrane review of 6 low- to moderate-quality trials (N = 497) found small reduction in cough at day 7 vs. placebo41, Cochrane review of 6 low- to moderate-quality studies (N = 915) found that acetaminophen and/or ibuprofen lowers temperature and may result in less discomfort59, 2 Cochrane reviews and 1 RCT found significant reduction in symptoms6,60,61, 2 sprays (0.03% or 0.6%) per nostril 3 or 4 times per day, Cochrane review of 7 RCTs (N = 2,144) without meta-analysis showed significant reduction in rhinorrhea but not nasal congestion vs. placebo62, RCT (N = 401) showed improved resolution of nasal symptoms; reduced use of antipyretics, mucolytics, and antibiotics; and fewer days missed from school (P < .05 for all)63, Ointment containing camphor, menthol, and eucalyptus oils, RCT (N = 138) found reduced cough, congestion, and sleep difficulty compared with petrolatum ointment or no treatment (P < .05 for all)64, 40 days to 28 weeks (typically about 3 months), Cochrane review of 29 trials found no benefit for preventing colds, but reduced symptom duration by 18% (about 1 to 2 days); starting vitamin C supplementation after symptom onset does not reduce symptom duration16. Ann Fam Med. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. Dooley L, Leukocytosis is present in about 20% of patients; significant leukocytosis is more likely with a bacterial infection than with bronchitis.21 Although rapid testing is available for some respiratory pathogens, it is usually not necessary in the typical ambulatory care patient.22 Testing for influenza and pertussis may be considered when the suspicion is high and treatment would impact the course of the illness. Holmes PW, Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Turner N, Guidelines for the management of adult lower respiratory tract infections—full version. 21. 17. JAMA. Acta Paediatr. ; et al. et al. et al. Application of ointment containing camphor, menthol, and eucalyptus oils on the chest and neck of children at bedtime can relieve nasal congestion and reduce nighttime cough frequency and severity, improving sleep for both the child and parents. The diagnoses that have the most overlap with acute bronchitis are upper respiratory tract infections and pneumonia. Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold. As predicted by the 2006 CHEST Cough Guidelines, the most common causes were respiratory infections, most likely of viral cause, followed by exacerbations of underlying diseases such as asthma and COPD and pneumonia. Hülsse C, Antibiotics for acute bronchitis. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care. Arch Intern Med. Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial. 32. et al. https://www.aafp.org/afp/recommendations/search.htm, https://www.cdc.gov/nchs/data/series/sr_10/sr10_200.pdf, https://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm263948.htm, https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report.pdf, https://www.aafp.org/afp/2012/0715/p153.html, https://www.aafp.org/afp/2007/0215/p515.html, Treatment of Threatened Miscarriage with Progestogens, Top POEMs of 2018 Consistent with the Principles of the Choosing Wisely Campaign. 1984;25(1):20–24. et al. Acetaminophen (paracetamol) for the common cold in adults. Two trials of antihistamines alone showed no benefit compared with placebo in relieving cough symptoms. et al. Beiler JS, 2015;(4):CD006821. Callahan-Lyon P, Wu T, Braman SS. Gayle YE, et al. ; ; A randomized, double-blind, placebo-controlled trial. 2018;(4):CD007094. JAMA. 6. Treatment of the Common Cold. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Bhasale AL, 2002;65(10):2039–2044. Cornia PB, Skoner DP, TARGet Kids! Tamm M, et al. 2013;(4):CD004417. Schütt T, Kumar AA, Guaifenesin is a commonly used expectorant. Kenia P, Avoid prescribing antibiotics for upper respiratory infections. Guerra CV, / Antibiotics for common respiratory tract infections in adults. One large trial found that children who use saline nasal washes six times per day have faster resolution of nasal secretions and nasal obstruction and reduced use of antipyretics, decongestants, and antibiotics. Hübner C, Cochrane Database Syst Rev. Delayed antibiotics for respiratory infections. The most common symptom is a cough. Comparing patients' expectations with data from a systematic review of the literature. The role of antibiotics is limited. Holmes PW, Chalker E. Hay AD, Wilm S, For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see https://www.aafp.org/afp/recommendations/search.htm. 44. Get Permissions, Access the latest issue of American Family Physician. Cough is the most common illness-related reason for ambulatory care visits in the United States. Outbreaks where food workers have been implicated in the spread of foodborne disease. Schouten EG, Accessed November 21, 2018. https://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm263948.htm. Acetaminophen (paracetamol) for the common cold in adults. Nicholson KG. Antibiotic prescribing for adults with acute bronchitis in the United States, 1996–2010. Spurling GK, Singh M, Slow S, Curran MD, 2019 Sep 1;100(5):281-289. Youngpairoj S. Respir Med. 1995;13(1):8–12. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 6. 9. Beynon GJ, Jani P, Baguley DM. van der Wouden JC. This article updates previous articles on this topic by Fashner, et al.,75 and by Simasek and Blandino.76. et al. Kim SY, Del Mar CB, Little P, King D, Collaboration. The most common adverse effects reported were nausea, diarrhea, headache, skin rash, and vaginitis with a number needed to harm of 5. We also searched the U.S. Food and Drug Administration website for specific information regarding changes in recommendations for the use of cough and cold medications in children. et al. Villasis-Keever M, Ann Fam Med. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. Withdrawn: zinc for the common cold. The Agency for Healthcare Research and Quality, National Guideline Clearinghouse, National Quality Measures Clearinghouse, and Essential Evidence Plus were also searched. Cochrane Database Syst Rev. Held U, et al. Oral antihistamine-decongestant-analgesic combinations for the common cold. 2014;(11):CD001831. ; Altunaiji S, et al. 2009;14(3):127–131. 2017;(8):CD001728. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Lacoin F, Bjerrum L. Archer RK. Murdoch DR, Crowell KR, Codeine is a centrally acting, weak opioid that suppresses cough. et al. Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography. JAMA. U.S. Food Drug Administration. Antibiotics for the common cold and acute purulent rhinitis. Parkin PC, Patients typically present with nasal congestion, rhinorrhea, sore throat, cough, general malaise, and/or low-grade fever. Shinder F. 2015;16:24. This clinical content conforms to AAFP criteria for continuing medical education (CME). Use caution when giving cough and cold products to kids. 75. Chinese medicinal herbs for acute bronchitis. AlBalawi ZH, ; Blasi F, 2013;63(613):e573–e579. 43. Oyo-Ita A, 2015;(9):CD001726. Shinder A, 2014;(11):CD010130. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Cochrane Database Syst Rev. Verheij TJ, Cochrane Database Syst Rev. Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Wodny M, Efficacy of isotonic nasal wash (sea-water) in the treatment and prevention of rhinitis in children. ; Satomura K, 2005;29(4):302–307. Fitzgerald JT, 63. 32. Mitchell B, Wilm S, 54. To see the full article, log in or purchase access. Kelly MJ, Pulmonary aspiration can present symptoms of wheezing, coughing, dyspnea, cyanosis, pulmonary edema, hypotension, and hypoxemia, which may progress rapidly to severe acute[kjccm.org] These cases usually resolve without antimicrobial therapy, with deep breathing and coughing, or with chest physiotherapy, when required. Application of ointment containing camphor, menthol, and eucalyptus oils on the chest and neck of children at bedtime can relieve nasal congestion and reduce nighttime cough frequency and severity, improving sleep for both the child and parents.64 The use of menthol alone may also improve perceived nasal patency but may not help with cough.65 Menthol is safe for use in children two years and older. Ebell MH. Karsch-Völk M, Address correspondence to Katharine C. DeGeorge, MD, MS, University of Virginia School of Medicine, Box 800729, Charlottesville, VA 22908 (email: Centers for Disease Control and Prevention. Perera R, et al. Steurer-Stey C, et al. Kukuruzovic R, et al. 2001;18(4):189–193. Guppy MP, Want to use this article elsewhere? Over-the-counter cough medications containing antihistamines and antitussives should not be used in children younger than four years because of the high potential for harm. Udoh EE, Five things physicians and patients should question. Acetylcysteine. 55. GRACE Consortium. Related Studies. Kenealy T, Michaels BS, Durec T, Zanasi A, Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism. Standish L, 2013;347:f5762. Respiratory tract infections in children in the community: prospective online inception cohort study. Fashner J, Delayed antibiotics for respiratory infections. Woelkart K, The diagnosis of pneumonia requires a chest radiograph (x-ray) – yes, no or sometimes? Kumar AA, BMJ. Additionally, there is no evidence that hydrocodone is useful in children. Hirschmann JV. et al. Honey for acute cough in children. Kiefer D, Snell LM, Dooley L, National Committee for Quality Assurance. 31. Low-quality studies suggest that increasing fluid intake in children with URIs actually causes harm.40, Intranasal and Oral Corticosteroids. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. Arch Pediatr Adolesc Med. A randomized, placebo-controlled, double-blind trial on the management of post-infective cough by inhaled ipratropium and salbutamol administered in combination. Cochrane Database Syst Rev. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. 34. 41. In 1990, it was the fifth most fre-quently managed problem by general ... acute cough concluded that any benefit from antibiotics was marginal and probably offset by potential side effects,6 while a more recent Cochrane review of acute bronchitis concludes that ‘there may be … 43. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. The diagnosis is made on the basis of clinical symptoms. A clinical evaluation of head impulse … Jaiswal N, Llor C, Sputum colour for diagnosis of a bacterial infection in patients with acute cough. Massie J. Cohen M. Contact Altiner A, Aiello AE, Hickner J. See the CME Quiz Questions. Brown RL, Safe and effective treatments for cold symptoms in children include nasal saline irrigation. 60. J Food Prot. Hersh AL, It is thought to stimulate respiratory tract secretions, thereby increasing respiratory fluid volumes and decreasing mucus viscosity, and it may also have antitussive properties. 2017;356:i6583. Günther J, et al. 28. Taylor JA, et al. The mucolytic acetylcysteine may safely decrease cough after six to seven days in children two years and older.41, Ipratropium. Predicting pneumonia in adults with respiratory illness. Does inhaling menthol affect nasal patency or cough? Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough. Bucher B, 47. How long does a cough last? ; Given minimal symptom improvement in an otherwise self-limited condition, increased rate of adverse effects, and potential for antibiotic resistance, it is wise to limit the use of antibiotics in the general population; further study in frail older persons and individuals with multiple comorbidities is needed.41 If pertussis is confirmed or suspected because of a persistent cough accompanied by symptoms of paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure, treatment with a macrolide is recommended.10, Delayed prescribing, in which the patient is given an antibiotic prescription at the visit but told not to fill it unless symptoms continue beyond a predetermined time, significantly decreases antibiotic use.42 A Cochrane review showed no difference in clinical outcomes between patients with acute bronchitis who were treated immediately with antibiotics and those with delayed or no antibiotic treatment. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. et al. Little P, Skoupá J, 35. SARAH N. DALRYMPLE, MD, is an assistant professor of family medicine at the University of Virginia Department of Family Medicine. Duijvestijn YC. Nonsteroidal anti-inflammatory drugs—mainly ibuprofen—have been shown to reduce headache, ear pain, muscle pain, joint pain, and sneezing but do not improve cough, cold duration, or total symptom score. Physical interventions to interrupt or reduce the spread of respiratory viruses. Paul IM, Fahey T. 74. Investigation of the effect of oxymetazoline on the duration of rhinitis. GRACE Project Group. The latest update on over-the-counter cough and cold product use in children. Intranasal ipratropium bromide for the common cold. Evaluation of the Patient with Chronic Cough - American ... Harvey SA, Wood DJ. Martineau AR, Chinese medicinal herbs for acute bronchitis. Arroll B. Copyright © 2019 by the American Academy of Family Physicians. Bolser DC. Physical interventions to interrupt or reduce the spread of respiratory viruses. Diagnosis and treatment of acute bronchitis. Taking them won't do any good this time and may hurt their chances of fighting bacterial infections you might get in the future.”, “You can try honey for your cough, ibuprofen or acetaminophen for your muscle aches, and nasal or oral decongestants with or without an antihistamine for your congestion.”, Manage expectations for length of illness, “Cold viruses can make you feel lousy. Briars LA. Das RR. Cornia PB, Hooper RL, Stolz D. Das RR. Enlarge Slapak I, Narrative: Acute bronchitis is a lower respiratory tract infection, most commonly viral, that accounts for a significant number of health care visits (100 million annually in the United States). Johnstone J, 2007;161(12):1140–1146. Mulder J. 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