TREATMENT OF COUGH
According to recommendations made by the American Academy of Paediatrics and the United Kingdom’s National Institute for Health and Clinical Excellence, the management of the common cold generally entails supportive care
Antiviral treatment
There is no specific antiviral treatment for rhinovirus infections, the most common cause of the common cold. Ribavirin, approved for severe RSV infections, does not work against colds. Neuraminidase inhibitors like oseltamivir and zanamivir have a limited effect on influenza symptoms in children if started early (within 48 hr of symptoms onset). Antibacterial therapy is not beneficial and should be avoided to prevent adverse effects and antibiotic resistance.
Supportive care for colds
Supportive care for colds includes maintaining oral hydration, ingesting warm fluids, and using topical nasal saline or irrigation. Cool, humidified air may help loosen nasal secretions, but steam and cool-mist therapy are not recommended by the World Health Organization. Nonprescription cold medications for children have questionable effectiveness and potential side effects. The American Academy of Pediatrics advises against their use in children under 6 years old. Zinc lozenges may reduce the duration of cold symptoms but do not have a consistent antiviral effect and can cause side effects like altered taste and nausea.
Fever
Fever is not usually associated with an uncomplicated common cold, and antipyretic treatment is generally not indicated.
Nasal obstruction
For nasal obstruction, topical or oral adrenergic agents are effective in older children and adults. Topical agents like xylometazoline, oxymetazoline, or phenylephrine are available as drops or sprays. Reduced-strength formulations can be used in younger children but not recommended for those under 6 years old. Rare systemic effects of imidazolines include bradycardia, hypotension, and coma. Avoid prolonged use to prevent rhinitis medicamentosa, a rebound effect causing nasal obstruction after discontinuation. Oral adrenergic agents are less effective and may have systemic side effects. Aromatic vapors like menthol may improve nasal sensation but not spirometry. Saline nose drops can help improve nasal symptoms and are suitable for all age groups.
Rhinorrhea
Rhinorrhea, or a runny nose, can be reduced by first-generation antihistamines, which may show a 25-30% improvement. This effect is linked to their anticholinergic properties, not their antihistaminic ones. Second-generation antihistamines, known as “nonsedating” antihistamines, do not affect common cold symptoms. Adverse effects of antihistamines include sedation and hyperactivity, and overdosing can lead to respiratory depression or hallucinations. Another treatment option is ipratropium bromide, a topical anticholinergic with effects similar to antihistamines but no sedation. Common side effects of ipratropium are nasal irritation and bleeding
Sore throat
For mild sore throats during colds, mild analgesics may be used if there’s accompanying myalgia or headache. Avoid giving aspirin to children with respiratory infections due to the risk of Reye syndrome. Nonsteroidal anti-inflammatory drugs may provide some relief but their effect on respiratory symptoms is uncertain. Consider the balance of benefits and harms when using them for colds.
Cough
For most cold-related coughs, cough suppression is not necessary. If the cough is due to postnasal drip, first-generation antihistamines may help. Cough lozenges or honey (for children ≥1 year old) can provide temporary relief. Avoid honey in children younger than 1 year due to the risk of botulism. In cases of virus-induced reactive airway disease, bronchodilators or other therapies may be beneficial. Codeine and dextromethorphan have no effect on cold-related coughs and can be toxic. Guaifenesin is not effective as a cough suppressant. Camphor, menthol, and eucalyptus oils may relieve nocturnal cough, but more research is needed to confirm their effectiveness.
Ineffective Treatments
Vitamin C, guaifenesin, and inhalation of warm, humidified air are ineffective for treating cold symptoms. Echinacea, a popular herbal remedy, also lacks evidence for common cold treatment. Antibiotics are not beneficial for the common cold or short-duration purulent rhinitis and may cause adverse effects.