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Continuity Clinic Notebook:

 Chapter II. The Evaluation of the Sick Child

Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT
--Otitis Media:
Classification, Rx and Complications
--Pediatric ENT:
1. When to Refer for Tubes
2. Laryngeal Abnormalities
--The Treatment of Otorrhea
--Eye Problems of Children
--Allergic Rhinitis
--Sinusitis vs. Purulent Rhinitis vs. URI

  

“Treatment” of the Common Cold

(Ref: Infectious Disease in Children Newsletter Jan 98)

Introduction: No matter what pediatricians advise, parents utilize over the counter (OTC) drugs frequently.  One study found that parents had given children an OTC med in their last illness 70% of the time.  In fact, 54% of children in one study had been given a med in the previous 30- day time period.  The question remains, do these medications give any therapeutic benefit to children with URIs?

No good studies in children, but it is clear that using these medications does not prevent otitis media, sinusitus, or asthma.

Differential Diagnosis of URI:

Condition Differentiating Features
Allergic Rhinitis Itching, sneezing, nasal eos
Foreign Body Unilateral foul smelling secretions
Sinusitis Unremitting rhinorrhea, fever, edema, headache
Streptococcal nasopharyngitis Excoriated nares that are secondarily infected

Medications:

Symptoms of URI Treatments Comments (side effects)
Nasal Obstruction Topical Adrenergic Agents more effective than oral agents (nasal irritation and rebound conges)
  Oral Adrenergic Agents tachycardia,
Rhinorrhea Antihistamine through anticholinergic effects (dry mouth, dry nose, urinary retention, drowsiness)
  Ipratropium 30% reduction of symptoms:(nasal dryness and bloody mucous)
Sore Throat Acetominophen Antibody response may be blunted
  NSAIDS by the use of these medications
Cough Topical Adrenergic agents antihistamine may be most important component
  Bronchodilators cough often result of bronchoconstriction and RAD
  Dextromethorphan data not clear if works in acute cough, but do help with chronic cough.

Toxicity: Well described even in therapeutic dosages.  Tachycardia, arrythmia, even death.

Conclusions: The use of medications for the common cold is high and represents a huge national expense.  Pediatricians should be aware that the use of most of these medications is of unproven efficacy, but parents will use them anyway.  We need to learn the ingredients of the most commonly used medications to best advise our patients which are the least dangerous to use.

Never use any po med for the common cold in infants under six months of age.

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004