Frequency: In the US: Common colds most frequently occur from September to April in temperate climates. RV infections, which are present throughout the year, account for the initial increase in cold incidence during the fall and a second incidence peak at the end of the spring season. Colds occurring from October through March are caused by the successive appearance of numerous viruses, including parainfluenza, coronavirus, RSV, and influenza virus. Adenoviral infections occur at a constant rate throughout the season.
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Rhinovirus Infection
Last Updated: August 31, 2004 Rate this Article
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Synonyms and related keywords: RV infection, common cold, upper respiratory infection, URI
AUTHOR INFORMATION Section 1 of 9
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Author: Mai Ngoc Nguyen, MD, Staff Physician, Department of Pediatrics, Mattel Children's Hospital, University of California at Los Angeles
Coauthor(s): James D Korb, MD, Program Director, Department of Pediatrics, Children's Hospital of Orange County
Mai Ngoc Nguyen, MD, is a member of the following medical societies: American Academy of Pediatrics, and American Medical Association
Editor(s): José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center; Robert Konop, PharmD, Clinical Assistant Professor, Department of Pharmacy, Section of Clinical Pharmacology, University of Minnesota; Larry I Lutwick, MD, Director, Division of Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Professor, Department of Internal Medicine, State University of New York at Downstate; Robert W Tolan, Jr, MD, Chief of Pediatric Infectious Diseases, St. Peter's University Hospital and Capital Health System, Clinical Associate Professor of Pediatrics, Drexel University College of Medicine; and Russell Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center
INTRODUCTION Section 2 of 9
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Background: Rhinoviruses (RVs) are small (30 nm), nonenveloped viruses that contain a single-strand ribonucleic acid (RNA) genome within an icosahedral (20-sided) capsid. RVs belong to the Picornaviridae family, which includes the genera Enterovirus (polioviruses, coxsackieviruses groups A and B, echoviruses, numbered enteroviruses) and Hepatovirus (hepatitis A virus). Approximately 101 serotypes are identified currently.
This review focuses on the common cold because it most frequently is associated with RV. Nasopharyngitis, croup, and pneumonia, which uncommonly are caused by RV, also are discussed briefly. RV plays a significant role in the pathogenesis of otitis media and asthma exacerbations. Although incidence and prevalence are high, most cases are mild and self-limited.
Pathophysiology: RV can be transmitted by aerosol or direct contact. Primary site of inoculation is the nasal mucosa, although the conjunctiva may be involved to a lesser extent. RV attaches to respiratory epithelium and spreads locally. The major human RV receptor is intercellular adhesion molecule-1 (ICAM-1). The natural response of the human defense system to injury involves ICAM-1, which aids the binding between endothelial cells and leukocytes. RV takes advantage of the ICAM-1 by using it as a receptor for attachment. In addition, RV uses ICAM-1 for subsequent viral uncoating during cell invasion. Some RV serotypes also up-regulate the ICAM-1 expression on human epithelial cells to increase infection susceptibility.
Optimum environment for RV replication is 33-35°C. RV does not replicate efficiently at body temperature. This may explain why RV replicates well in the nasal passages and upper tracheobronchial tree but less well in the lower respiratory tract. Incubation period is approximately 2-3 days. Viremia is uncommon.
RV is shed in large amounts, with as many as 1 million infectious virions per milliliter of nasal washings. Viral shedding can occur a few days before cold symptoms are recognized by the patient, peaks on days 2-7 of the illness, and may last for as many as 3-4 weeks.
A local inflammatory response to the virus in the respiratory tract can lead to nasal discharge, nasal congestion, sneezing, and throat irritation. Damage to the nasal epithelium does not occur, and inflammation is mediated by the production of cytokines and other mediators.
Histamine concentrations in nasal secretions do not increase. By days 3-5 of the illness, nasal discharge can become mucopurulent from polymorphonuclear leukocytes that have migrated to the infection site in response to chemoattractants such as interleukin-8. Nasal mucociliary transport is reduced markedly during the illness and may be impaired for weeks. Both secretory immunoglobulin A and serum antibodies are involved in resolving the illness and protecting from reinfection.
Coronaviruses, reinfections with parainfluenza, and respiratory syncytial virus (RSV) are the most important of many other viruses that can cause common colds. Other viruses (eg, adenoviruses, influenza viruses) also can cause common colds but are more likely to cause acute nasopharyngitis and more severe respiratory infections.
Mycoplasma pneumoniae occasionally can present with common cold symptoms before developing into more extensive respiratory disease. Other pathogens include Coccidioides immitis, Histoplasma capsulatum, Bordetella pertussis, Chlamydia psittaci, and Coxiella burnetii.
Recent clinical studies indicate sinus involvement in common colds. CT scan abnormalities (eg, opacification, air-fluid levels, mucosal thickening) are present in adults with common colds that resolve over 1-2 weeks without antibiotic therapy.
Folklore to the contrary, no good clinical evidence reports that colds are acquired by exposure to cold weather, getting wet, or becoming chilled.
Frequency:
In the US: Common colds most frequently occur from September to April in temperate climates. RV infections, which are present throughout the year, account for the initial increase in cold incidence during the fall and a second incidence peak at the end of the spring season. Colds occurring from October through March are caused by the successive appearance of numerous viruses, including parainfluenza, coronavirus, RSV, and influenza virus. Adenoviral infections occur at a constant rate throughout the season.
Numerous studies demonstrate common cold incidence to be highest in preschool and elementary school-aged children. An average of 3-8 colds per year is observed in this age group, with an even higher incidence for children attending day care and preschool. Given the numerous viral agents involved and the many serotypes of several viruses (especially RV), younger children having new colds each month during the winter season is not unusual. Adults and adolescents typically have 2-4 colds per year.
Internationally: Seasonal increase in incidence during the winter months is observed worldwide.
Mortality/Morbidity: The most common manifestation of RV, the common cold, is mild and self-limited. However, rarely severe respiratory disease, including bronchiolitis and pneumonia, can occur in infants.
Race: American Indian and Eskimo people are more likely to develop the common cold and appear to have more frequent complications such as otitis media. These findings may be explained as much by environmental conditions (eg, poverty, overcrowding) as by ethnicity.
Age: Since antibodies to viral serotypes develop over time, highest incidence is found in infants and younger children. In addition, younger children are more likely to have the frequent, close, personal contact necessary to transmit RV. Contrary to the experience of adults, children also may be more contagious due to having higher virus concentrations in secretions and longer duration of viral shedding. CLINICAL Section 3 of 9
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History: RV directly can cause or indirectly can predispose to a variety of upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI), which are less common.
Common cold
Nose dryness or irritation often is the first symptom and is followed within hours by profuse watery rhinorrhea, nasal congestion, and sneezing.
A sore throat or throat irritation is common.
Malaise, headache, and cough also are common symptoms of the common cold.
Fever is absent or low grade. Infants and preschoolers are more likely to experience fevers, which are often 38-39°C.
Nasal secretions typically become thicker and colored after the first few days of illness.
Irritability or restlessness is common.
Nasal obstruction can interfere with sleep and feeding.
Posttussive vomiting can occur.
Symptoms in adults and adolescents usually resolve by day 7; however, symptoms often last 10-14 days in younger children.
Acute otitis media
Viral URIs are common precipitating factors for acute otitis media (AOM), probably by causing respiratory mucosal inflammation, leading to eustachian tube obstruction.
Respiratory viruses are found in either the middle ear fluid or nasopharynx in approximately 40% of patients with AOM.
As many as 24% of patients with AOM have RV present in nasopharyngeal secretions. RV also has been obtained from middle ear fluid.
Patients whose symptoms are refractory to treatment with antibiotics are more likely to have positive viral cultures from the middle ear.
Sinusitis
Viral respiratory infections commonly cause more frequent and more severe asthma exacerbations in individuals of all ages.
Preceding RV infection can lead to bacterial superinfection.
Asthma exacerbations
Viral URI is the most common trigger for asthma exacerbations in children of all ages.
For children younger than 5 years, RV and RSV are the most commonly implicated pathogens. RV is the most commonly implicated pathogen for older children.
LRTI: RV may cause both pneumonia and bronchiolitis in infants.
Croup: RV may cause laryngotracheobronchitis in infants.
Acute nasopharyngitis
The patient's physical examination reveals nasal discharge and a sore throat, including throat inflammation (eg, erythema, exudate, ulcers). Fever is common and can be high.
Acute nasopharyngitis most commonly is caused by adenovirus, enteroviruses, influenza, and parainfluenza.
RV is an uncommon cause of acute nasopharyngitis.
Common colds, by definition, do not have objective evidence of pharyngeal irritation.
Cystic fibrosis: RV is the implicated virus in as many as 57% of respiratory exacerbations.
Transmission modes
RV possesses a variety of transmission modes and can infect a huge population at any given time.
Aerosol transmission is the most common transmission mode for respiratory tract infections (RTIs). Transmission occurs when small airborne particles are inhaled or large droplets are touched directly.
Direct hand contact with infected secretions or indirect contact with fomites that contain secretions also is important. Patients then infect themselves by touching their noses or conjunctivae.
Highly contagious behavior includes nose blowing, sneezing, and physically transferring infected secretions onto environmental surfaces or paper tissue.
Contrary to popular belief, behaviors such as kissing, talking, coughing, or even drooling do not contribute highly to the spread of disease.
Infection rates approximate 50% within the family household and range from zero to 50% within schools, which indicates that transmission requires long-term contacts with infected individuals. Brief exposures to others in places such as the movies, shopping malls, friends' houses, or doctors' offices present low risks of infection transmission.
Incubation period is approximately 2-4 days.
Because children carry the fewest antibodies, children attending school are the most common reservoirs of RV infection.
Physical:
Common cold
The common cold usually is afebrile, although temperatures of 38-39°C are possible in younger children.
Profuse nasal discharge can be clear and watery or mucopurulent. Purulent secretions are common after the first few days of illness and do not imply bacterial sinusitis unless secretions persist for more than 10-14 days.
Edema and erythema of nasal mucosa occur.
Despite the sore throat symptom, the pharynx has a normal appearance, without any erythema, exudate, or ulceration.
Mildly enlarged nontender cervical lymph nodes are present.
Causes:
Factors that increase infection risk and severity
Smoking increases risk of respiratory infection by approximately 50%.
Very young or old individuals are at greater risk, possibly because of decreased immunity.
Exposure to infected contacts increases infection risk.
Touching the conjunctiva or nose with contaminated fingers and/or objects increases infection risk.
Crowding leads to increased transmission.
Men may have a slightly, probably insignificant, higher risk.
Feeding on breast milk has little, if any, effect on the incidence of common colds.
Underlying chronic medical conditions, including anatomic, metabolic, genetic, or immunologic disorders (ie, tracheoesophageal fistulas, congenital heart disease, cystic fibrosis, immunodeficiencies) increase infection risk and severity.
DIFFERENTIALS Section 4 of 9
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Allergic Rhinitis
Bronchiolitis
Bronchitis, Acute and Chronic
Pertussis
Pneumonia
Sinusitis
Other Problems to be Considered:
Acute nasopharyngitis
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WORKUP Section 5 of 9
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Lab Studies:
Diagnostic studies generally are unnecessary for patients with the common cold.
Clinical signs and symptoms of the common cold, by definition, are similar regardless of the infectious etiology.
In addition, with approximately 100 different serotypes of RV alone, assisting the diagnosis by serologic methods is economically impractical.
WBC has little value in the workup of the common cold.
If a specific viral diagnosis is desired, the virus can be cultured from nasal secretions.
Nasal washings are more sensitive than throat specimens.
Direct antigen tests are routinely available for influenza and RSV. Some centers offer direct antigen tests for parainfluenza and adenovirus.
Imaging Studies:
Routine use of imaging studies is unnecessary.
More than 85% of patients with the common cold have sinus abnormalities on CT scan. Do not make a bacterial sinusitis diagnosis if symptom duration is fewer than 10-14 days.
TREATMENT Section 6 of 9
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Medical Care:
The following treatment options are still experimental and not proven:
Developing a vaccine: Development of a vaccine is nearly impossible because of the numerous serotypes. No antiviral agents for treating infections exist.
Accelerating nasal drainage: Hot chicken soup causes a temperature increase that accelerates nasal drainage. Be aware of possible hypernatremia.
Providing inhaled, warm, humidified air: Nasal hyperthermia is based on the fact that increased temperatures inhibit RV replication in vitro. Inhaled, warm, humidified air (40 L/min at 40-44ºC in nostrils) has produced inconsistent findings among several studies.
Using aroma rubs, homeopathic and/or herbal remedies, and ultrafine high-volume filtration systems: These treatment options have yet to be studied.
Using experimental drugs: Many experimental drugs currently are in trials or have not been approved for consumer use. These include capsid-binding agents, pirodavir, WIN 54954, intranasal interferon (IF), virus receptor blockers, antireceptor antibodies, and soluble ICAM-1.
Most treatment provides supportive measures for respiratory illness symptoms. Conventional treatments for the common cold include the following:
Obtaining phenol-alcohol environment and solution (Lysol) to disinfect the environment
Washing hands
Obtaining rest, plenty of fluids, and reassurance that the usual viral course is 6-10 days
Positioning mattress at a 45° angle
Providing comfortable surrounding temperature and adequate humidity: This treatment method soothes irritated nasopharyngeal mucosa and helps eliminate nasal secretions by preventing dryness.
Using decongestants: Decongestants and antihistamines are not recommended for children younger than 6 months.
Using nasal saline drops with bulb syringe nostril aspiration: This treatment can help infants with congestion and obstruction.
Discontinuing smoking or using alcohol
Consultations: Refer to an allergist if patient has chronic rhinitis unresponsive to environmental and pharmacologic intervention.
MEDICATION Section 7 of 9
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Symptomatic treatment with analgesics, decongestants, antihistamines, and antitussives is currently the mainstay of therapy. Some clinicians advocate supplementation with vitamin C; however, high doses in children are not recommended. Zinc lozenges are not practical because of the metallic taste. The investigational agent pleconaril may be approved soon. Pleconaril is a capsid-binding isoxazole drug that induces conformational changes after binding to the RV shell, leading to altered receptor attachment. It inhibits viral uncoating, thus inhibiting replication.
Other drugs that are currently experimental or not approved for rhinovirus include the following:
Interferon alpha: Most effective for cold prevention, interferon alpha is ineffective for established colds. When administered through nasal spray, 80% of secondary RV colds were prevented. Interferon alpha is not cost-effective. Significant adverse effects exist.
Pirodavir: A substituted phenoxy-pyridazinamine, pirodavir possesses broad antipicornavirus activity. Clinical studies demonstrate no decrease in viral shedding or symptoms.
WIN 54954: A methylisoxazole derivative, WIN 54954 has no significant antiviral or clinical effects.
Virus receptor blockers: These drugs are hypothesized to block virus internalization to prevent replication.
Antireceptor antibody: Tests demonstrate no decrease in infection frequency.
Soluble ICAM-1: This drug consists of a molecule that blocks replication by binding receptor sites and inhibiting viral attachment and internalization. Currently, no clinical trials exist.
Drug Category: Analgesic and antipyretic agents -- For relief of pain, discomfort, or fever. Inhibits central synthesis and release of prostaglandins that mediate effect of endogenous pyrogens in hypothalamus; thus, promotes return of set-point temperature to normal. Ibuprofen also possesses anti-inflammatory properties.Drug Name
Ibuprofen (Motrin, Advil) -- One of few NSAIDs indicated for reduction of fever.
Adult Dose 200-400 mg PO q4-6h while symptoms persist, not to exceed 3.2 g/d
Pediatric Dose 5-10 mg/kg/dose PO q6-8h, not to exceed 40 mg/kg/d
Contraindications Documented hypersensitivity; aspirin; active GI bleeding and ulcer disease
Interactions Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy; caution in infants and young children; do not use in neonates secondary to CNS effects
Drug Name
Acetaminophen (Tylenol, Feverall, Tempra) -- Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.
Adult Dose 325-650 mg PO q4-6h or 1000 mg tid/qid, not to exceed 4 g/d
Pediatric Dose 10-15 mg/kg/dose PO/PR q4-6h, not to exceed 4 g/d
Contraindications Documented hypersensitivity; known G-6-PD deficiency
Interactions Rifampin can reduce acetaminophen analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Contained in many OTC products, and combined use with these products may result in cumulative doses exceeding recommended maximum dose; caution parents regarding varying concentrations of OTC products
Drug Category: Antihistamines -- Relieve runny nose, watery eyes, or other allergiclike symptoms. Act by competitive inhibition of histamine at H1 receptor. This mediates wheal and flare reactions, bronchial constriction, mucous secretions, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.Drug Name
Brompheniramine (Dimetapp, Dimetane) -- Alkylamine antihistamine primarily used for treating allergic symptoms.
Adult Dose Regular release: 4 mg PO q4-6h
SR: 8 mg PO q8-12h; 12 mg PO q12h
Pediatric Dose <6 years: 0.5 mg/kg/d PO divided q6-8h, not to exceed 6-8 mg/d
6-12 years: 2-4 mg/dose PO q6-8h, not to exceed 12-16 mg/d
>12 years: Administer as in adults
Contraindications Documented hypersensitivity; narrow-angle glaucoma; bladder neck obstruction; concurrent use of MAOIs
Interactions Potentiates effect of CNS depressants; MAOIs, sympathomimetics; propranolol
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions High blood pressure; heart disease; diabetes; thyroid disease; asthma; glaucoma
Drug Category: Decongestants -- Relieve congestion of nasal passages or sinuses.Drug Name
Pseudoephedrine (Sudafed) -- Stimulates vasoconstriction by directly activating alpha-adrenergic receptors of respiratory mucosa. Also induces bronchial relaxation and increases heart rate and contractility by stimulating beta-adrenergic receptors.
Adult Dose 60 mg q4-6h or 120 mg SR q12h, not to exceed 240 mg/d
Pediatric Dose 6-12 years: 4 mg/kg/d PO divided q6h
>12 years: 30-60 mg/dose PO q6-8h, not to exceed 240 mg/d
Contraindications Documented hypersensitivity; severe anemia; postural hypertension or hypotension; closed-angle glaucoma; head trauma; cerebral hemorrhage
Interactions Propranolol, MAOIs, and sympathomimetic agents may increase toxicity; methyldopa and reserpine may reduce effects
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions Hyperthyroidism; diabetes mellitus; prostatic hypertrophy; mild-to-moderate hypertension; arrhythmia; hyperglycemia
Drug Name
Phenylephrine nasal (Neo-Synephrine) -- Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity; produces vasoconstriction of arterioles, which decreases congestion.
Adult Dose 2-3 gtt or 1-2 sprays intranasally of 0.5% solution q4h
Pediatric Dose 6-12 months: 1-2 gtt intranasally of 0.16% solution q3h prn
1-6 years: 2-3 gtt intranasally of 0.125% solution q4h prn
6-12 years: 2-3 gtt intranasally or 1-2 sprays of 0.25% solution q4h prn
>12 years: 2-3 gtt intranasally or 1-2 sprays of 0.5% solution q4h
Contraindications Documented hypersensitivity; pheochromocytoma and severe hypertension; acute pancreatitis; hepatitis; myocardial disease; severe coronary disease; peripheral or mesenteric vascular thrombosis
Interactions Bretylium may potentiate action of vasopressors on adrenergic receptors, possibly resulting in arrhythmias; MAOIs significantly may enhance adrenergic effects, and pressor response may be increased 2- to 3-fold; guanethidine may increase pressor response of direct-acting vasopressors, possibly resulting in severe hypertension
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Arrhythmia; hyperthyroidism; hyperglycemia
Drug Category: Antitussive agents -- Act either centrally or peripherally on cough reflex or combination of both. Central acting agents increase threshold of cough center in brain to incoming stimuli, whereas those acting peripherally decrease sensitivity of receptors in respiratory tract.Drug Name
Dextromethorphan (Robitussin, Delsym) -- Antitussive and/or expectorant that comes as single entity or in variety of cough and cold preparations in various combinations.
Adult Dose Regular release: 10-30 mg PO q4-8h, not to exceed 120 mg/d
SR: 60 mg PO bid
Pediatric Dose 1-3 months: 0.5-1 mg PO q6-8h
3-6 months: 1-2 mg PO q6-8h
7 months to 1 year: 2-4 mg PO q6-8h
2-6 years: 2.5-7.5 mg PO q4-8h, not to exceed 30 mg/d
6-12 years: 5-10 mg PO q4-6h, not to exceed 60 mg/d
>12 years: Administer as in adults
Contraindications Documented hypersensitivity
Interactions May decrease hypotensive effects of guanethidine; MAOIs significantly may enhance adrenergic effects
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions High blood pressure or tachycardia; thyroid disorders; diabetes mellitus
Drug Name
Codeine -- For symptomatic relief of cough. Helpful for pain of intercostal muscle strain associated with cough. Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception and response to pain.
Adult Dose 10-20 mg/dose PO q4-6h prn for cough, not to exceed 120 mg/d
Pediatric Dose 1-1.5 mg/kg/d PO divided q4-6h prn
Contraindications Documented hypersensitivity; children <2 y
Interactions CNS depressants; TCAs may potentiate codeine effects; phenothiazine may antagonize analgesic effect; dextromethorphan may enhance analgesic effect
Pregnancy D - Unsafe in pregnancy
Precautions Hypersensitivity reactions to other phenanthrene-derivative opioid agonists; respiratory diseases; severe liver and/or renal insufficiency
Drug Category: Antipicornaviral agents -- Experimental agents that may reduce duration and severity of respiratory symptoms.Drug Name
Pleconaril (Picovir) -- Capsid-binding isoxazole drug that induces conformational changes, leading to altered receptor attachment. Also inhibits viral uncoating. May be licensed for use soon.
Adult Dose Experimental dose: 200-400 mg PO tid pc
Pediatric Dose Experimental dose: 5 mg/kg/dose PO q8-12h pc
Contraindications Documented hypersensitivity
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions Renal or hepatic dysfunction; pregnancy because data are lacking
Drug Category: Vitamin C -- May decrease severity and duration (large doses not recommended for children).Drug Name
Ascorbic acid (Vita-C) -- Effect on cold severity and duration is still controversial. Vitamin C comes in variety of formulations.
Adult Dose Dietary supplement: 50-200 mg/d PO
Prevention and treatment of cold: 1-3 g/d PO
Pediatric Dose Dietary supplement: 35-100 mg/d PO
Contraindications Documented hypersensitivity; pregnancy if large doses administered
Interactions Decreases effects of warfarin and fluphenazine; increases aspirin levels
Pregnancy A - Safe in pregnancy
Precautions Prolonged high doses may cause renal calculi, especially in patients with diabetes
FOLLOW-UP Section 8 of 9
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Further Outpatient Care:
Advocate supportive measures such as rest, analgesics, and adequate hydration.
Instruct per Patient Education.
Deterrence/Prevention:
Avoid aspirin if a child has a viral illness because Reye syndrome complication is possible.
Prognosis:
Complete recovery usually is observed within 7 days for adolescents and adults and within 10-14 days for children. Occasionally, a child's cough and congestion linger for 2-3 weeks.
Patient Education:
Reassure family and patient that frequent colds are common at certain times of the year.
Advising parents that 6-12 colds per year can be normal for young children, especially if they are attending day care or preschool, is helpful.
Frequent self-limited colds do not indicate a problem with the child's immune system and do not require antibiotic treatment.
Because spread of secretions by contact with hands is a major route of transmission, encourage parents and patient to wash their hands frequently.
Advise patient to return to the clinic if fever exceeds 102°F, significant respiratory distress develops, or symptoms do not resolve in 10-14 days.
Advise patient that purulent nasal discharges commonly are observed after the first few days of the infection and do not indicate a bacterial infection or the need for antibiotics.
Patients with common colds do not need to be excluded from day care or preschool settings.
For excellent patient education resources, visit eMedicine's Cold and Flu Center. Also, see eMedicine's patient education article Colds.
BIBLIOGRAPHY Section 9 of 9
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Bibliography
Arruda E, Hayden FG: Update on therapy of influenza and rhinovirus infections. In: Advances in Experimental Medicine and Biology. 1996; 394: 175-87.
Atmar RL, Dick EC, Byers RL: Rhinoviruses. In: Oski's Pediatrics, Principles and Practice, 3rd ed. 1999: 1084-1086, 1217, 1276-1280.
Bella J, Rossmann MG: Review: rhinoviruses and their ICAM receptors. J Struct Biol 1999 Dec 1; 128(1): 69-74[Medline].
Busse WW, Gern JE, Dick EC: The role of respiratory viruses in asthma. Ciba Foundation Symposium 1997; 206: 208-213.
Denny FW Jr: The clinical impact of human respiratory virus infections. Am J Respir Crit Care Med 1995 Oct; 152(4 Pt 2): S4-12[Medline].
Dershewitz RA, Macknin ML: The common cold. In: Ambulatory Pediatric Care, 3rd ed. 1999: 834-36.
Greve JM, Davis G, Meyer AM, et al: The major human rhinovirus receptor is ICAM-1. Cell 1989 Mar 10; 56(5): 839-47[Medline].
Monto AS: Viral respiratory infections in the community: epidemiology, agents, and interventions. Am J Med 1995 Dec 29; 99(6B): 24S-27S[Medline].
Peter G: Rhinovirus. In: 1997 Red Book: Report of the Committee on Infectious Diseases, 24th ed. 1997: 448.
Pitkaranta A, Hayden FG: Rhinoviruses: important respiratory pathogens. Ann Med 1998 Dec; 30(6): 529-37[Medline].
Romero JR: Pleconaril: a novel antipicornaviral drug. Expert Opin Investig Drugs 2001 Feb; 10(2): 369-79[Medline].
Siberry GK, Iannone R: The Harriet Lane Handbook, 15th ed. 2000.
Smith MB: Acute rhinitis and pharyngitis. In: Evidence-Based Pediatrics. 2000: 83-90.
Spiteri MA, Bianco A: The clinical and biological impact of viral respiratory infections on the human airway: focus on the rhinovirus. Monaldi Arch Chest Dis 1998 Feb; 53(1): 80-2[Medline].
Yamaya M, Sekizawa K: Rhinovirus infection of primary cultures of hum tracheal epithelium: role of ICAM-1 and IL-1 beta. Am J Physiology 1997; 273: L749-59.
Zambrano JC, Rakes GP: Virus-induced wheezing in children. Immunology and Allergy Clinics of North America 1998; 18: 35-47.
NOTE:
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER
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