PDF Emergency Medicine Grand Rounds
Emergency Medicine Grand Rounds
Updated February 2019
The Common Cold, Influenza and Sinusitis:
Keith Conover, M.D., FACEP
Evidence-Based Treatment of Acute Rhinosinusitis
Department of Emergency Medicine University of Pittsburgh
"Support your local fever."
Fever helps kill viruses and bacteria.
Suppressing fever makes you sicker
and sick longer.
Recommendations
1. Antiviral antibiotic zinc (ZiCam Rapidmelts) will shorten your cold by 1-2 days.
2. Combination cold medications, Motrin, Aleve, aspirin and acetaminophen (Tylenol) will make you feel better but get sicker.
3. Don't treat fever < 104?F (40?C); do use an electric blanket for muscle aches and to kill viruses and bacteria. Use a zap-in-themicrowave heat pack on the sinuses.
4. Use honey, naproxen and 12-hour dextromethorphan for bad cough.
5. Use oxymetazoline (Afrin) nasal spray up to 10 days, for those > 2 years old.
6. Use salt water saline nasal spray frequently. For infants, use a blue bulb syringe to suck out the nose afterwards.
7. If cold worse at 5-6 days, or lasts > 10 days for adults (14 days for kids) still with cough, nasal discharge, fever, or sinus pain, use a steroid nasal spray and consult a doctor for an antibacterial antibiotic.
It happens to us all. The common cold. It's not an "emergency," but people want an instant cure.
Causes
Colds are "caused" by rhinovirus (>100 types of picornavirus), coronavirus, adenovirus, coxsackievirus, echovirus, orthomyxovirus, paramyxovirus (parainfluenza), enterovirus, metapneumovirus, influenza (flu), and respiratory syncytial virus (RSV), which is severe in kids but mild in adults and may cause asthma. Still, we don't know the cause of ?-? of colds. Some "infected" with a cold virus don't even notice it! Colds with bacterial overgrowth (~20%, usually S. pneumoniae, H. influenzae, or M. catarrhalis) are worse; but antibiotics don't help.1 Whooping cough from Bordetella pertussis acts like a cold, with strings of bad cough that can cause vomiting, and often with red eyes; treat with azithromycin as pertussis tests are not easily available and take a long time.
Winter is cold and flu season, maybe from crowding or cold noses. Being out in the cold briefly doesn't cause colds,2 but cold feet will "cause" a cold, likely from viruses replicating better in cold, which is why I recommend an electric blanket.3 Sleep deprivation makes you twice as likely to get a cold.4 Flu vaccines make you 50% less likely to get the flu or a cold that is really mild flu. Flu vaccines also protect against heart attack and stroke,5,6 and are safe and effective for pregnant women, protecting the unborn baby.7
Stress and allergic rhinitis make colds more likely, though exercise ? except strenuous military PT ? doesn't, nor does diet or big tonsils.8 ICAM-1, the cell membrane receptor that rhinovirus uses to infect cells, increases with dust, pollen and tobacco smoke, predisposing to colds.9 Those with vitamin D deficiency are more likely to get colds,10 and vitamin D supplementation can prevent colds (but not the flu as some have said)11 Those who taste bitter better are less likely to get colds.12 If you feel lonely your cold will be worse.13
Epidemiology and Economics (US figures)
? 1 billion colds/yr
? Kids: every 6 weeks; once/month if in school/daycare9
? Adults: 2-4/yr, decreases with age
? 1.6 million (of 43.8 million) ED visits in 1998
? 22 million school days/yr lost
? >$20 billion/year work loss (>1/3 caring for sick kids)
? We spend $4 billion a year on OTC cold medications
? We spend $400 million/year on "cold" medications
Natural History/Symptoms
Onset is ~10 hours; symptoms peak in 2-3 days, and last 2-14 days, smokers 3 days longer.14 A cold is contagious from a day before symptoms to 5 days (flu: 5-7 days) after.
Symptoms depend more on you than the specific virus. It usually starts with a sore throat (usually normal on exam) ? helpful to distinguish a cold from allergy ? as well as coryza: red, swollen nasal mucosa (not pale and boggy like allergy) and clear nasal drainage. Later, there is catarrh: purulent yellow-green nasal discharge. Colored drainage does not mean bacterial infection.15 With a winter cold, adults get chills and a low body temperature, but kids < 12 usually get a fever. Even
courtesy
adults with a summer cold often get a fever for 2-3 days.16 Poor appetite, malaise, and headache are common; half get muscle aches (myalgias) but not as bad as with influenza. This is from cytokines, which is why non-steroidal anti-inflammatory drugs (NSAIDs: ibuprofen = Motrin, Advil, Nuprin and naproxen = Aleve), and acetaminophen (Tylenol), which inhibit cytokines, make you feel better temporarily.17 But, cytokines fight infection. NSAIDs and acetaminophen make you sicker, sick longer, and more likely to spread your cold or flu to others;18 British statisticians looked at US data and estimated that people taking cold/flu medicines with NSAIDs or acetaminophen kills ~700 people each US flu/cold season.19 Some argue that acetaminophen and NSAIDs make feverish kids better able to eat, but Zofran (ondansetron) nausea medicine is likely safer. Cough is universal, and the major cause of medical visits.8,15 If winter and there's fever (in adults) and bad myalgias (muscle aches), especially if vomiting or diarrhea, then it's likely influenza. Rapid influenza tests miss 1/3-2/3 of flu cases.20-24
Complications
Almost a quarter of kids with a cold get an ear infection. Pneumonia is common after a cold, often mixed viral and bacterial, especially in kids. Asthma usually gets worse with a cold. Flu makes you more likely to have a heart attack.6
Cough
Colds are the #1 cause of cough.25 Most OTC (over-thecounter) and (prescription) medicines ? including guaifenesin (Robitussin, Mucinex) and diphenhydramine (Benadryl) are useless; codeine is useless and has bad side effects, kills infants, and is addictive.26-33 Benzonatate (Tessalon) does little for cough, and if you take too much, you may seize or die.34-37 Dextromethorphan (DM) is the best of the over-the-counter and prescription cough medicines, but doesn't help much; sustained-release 12-hour syrups are best. Honey is as good as DM but works by a different mechanism so use both; avoid in kids 10 days or you'll have to use it the rest of your life to breathe through your nose (rhinitis medicamentosa).50,53
Ipratropium (Atrovent) nasal spray ( only, $56 for generic) helps a bit.53 Steroid sprays (e.g., Flonase, Nasonex) don't help colds,54 but help sinusitis.55-57 Saline (salt water) spray helps colds58 and sinusitis.59,60 Don't use a neti pot with unboiled tap water unless you want an amebic brain abscess. Sealed, pressurized saline is best.
Myalgia/Malaise/Fever
Many "colds" are mild influenza: don't take aspirin which can cause Reye's Syndrome (liver failure). Both aspirin and acetaminophen (e.g., Tylenol) make your nose more stuffy, and make you sick longer.61 Tylenol worsens asthma,62 and ibuprofen (Motrin, Advil, Nuprin) likely does too.63 NSAIDS decrease malaise, myalgias and cough.64 But fever fights infections;19,65,66 suppressing fever makes you sicker
and spreads infection. Treating the fever of the flu kills 700 people a year in the US.19 Treat only if >104?F=40?C. An electric blanket is
probably better than medicine!
Combination Cold Medications
Combination medications (e.g., Theraflu, NyQuil, DayQuil) include two or more of: acetaminophen (Tylenol; see above); an antihistamine; a decongestant; or a cough suppressant. Useless for those < 12, they also kill those under 2 who get the wrong dose.67 Manufacturers can afford expensive lobbyists; thus, they can market useless medications to children 2-12. Canada does not allow marketing to kids under 6.68 2/3 of US homes have combination cold meds;69 even in adults, there's no real evidence they help. Given bad side effects, avoid them.27
Zinc, "Alternative" Therapies and Homeopathy
ZiCam zinc nasal spray was sold as "homeopathic" (to get around FDA regulations) but it contained large concentrations of zinc. The FDA made them stop selling
it after hundreds permanently lost their sense of smell.70 ZiCam Nasal Spray is now just expensive Afrin. Zinc oral spray and lozenges (e.g. ZiCam), however, are safe and effective: if you start within 24 hours, will make you feel 10-20% better and shorten your cold (or maybe flu) by 1-2 days. It's an antiviral antibiotic.71
To make a homeopathic remedy, put a tiny bit of an ingredient that cause the symptoms you want to cure, sometimes a poison. Dilute this over and over while hitting the bottle with a leather paddle (has to be leather). This magically changes the water, even though there may not be a single molecule of the original ingredient left. Properly-prepared homeopathic remedies are harmless, though they may keep you from getting something better;72 recently one homeopathic teething gel was not properly prepared and killed 10 babies.
Hot baths are long recommended,73 and fever kills viruses,65 as may warmth on the sinuses. Breathing warm, humidified air for 20 minutes helps in the UK (where there is little central heat: colder noses?) and Israel, but not in the US.74,75
Echinacea,76 Vitamin C77 and garlic78 are useless for treatment. Vitamin C prevents colds at the risk of kidney stones.77,79 Chicken soup improves nasal mucus drainage,80 and decreases inflammation.81 Some prescribe steroids such as prednisone. I can find no evidence in the literature that oral steroids will help a common cold. However, short courses of steroids double or triple the risk of deep venous thrombosis, longbone fracture, or overwhelming bacterial sepsis.82
This work is licensed under the Creative Commons
Influenza
Attribution-Share Alike 3.0 Flu treatment is the same as for a cold, but also the prescription nausea
United States License. To view a copy of this license,
medication ondansetron (Zofran) and the OTC diarrhea medication loper-
visit . amide (Imodium-AD) may help. Oseltamivir (Tamiflu) can help influenza.83
org/licenses/by-sa/3.0/us/ For healthy people, it only helps if started within 48 hours; side effects oCSuroismteenm3d0o0an,slSe,ta1tne7r1FtrSoaenCccorinesacdtoiS,vtereet,irneccolumdme veonmdeitdinifg,ypousy'rcehaodsmis iatnteddktiodntheeyhfaoislupirtea.lE, pvreenganfatnert,4N8ahtiovuerAs,mCeDrCic-an/ California, 94105, USA. Alaskan, very old or very young, morbidly obese, nursing home resident, or
have significant chronic illness including asthma or diabetes. In 2017, H3N2
influenza killed 80,000 people in the US, and it's contagious from a day before
symptoms until 5-7 days later. Don't kill people: stay home for 7 days.
This license lets others remix,
tweak, and build upon your
Colds vs. "Sinusitis"
work even for commercial
purposes, as long as they Three days of nasal congestion, and now your snot is yellow, green or
credit you and license their new creations under the identical terms. This license is often compared
purple? An antibacterial antibiotic will not help. Really. Despite this 53% think they need an antibacterial antibiotic for a cold,84,85 and thousands of doctors give them.85 Call a cold acute viral rhinosinusitis: yes, your sinuses are
to "copyleft" free and open infected ? but with a virus and you need the antiviral antibiotic zinc. Some
source software licenses. All new works based on yours will carry the same license, so
colds have bacterial outweighed by side
superinfection,86 effects, especially
but antibacterial diarrhea.
antibiotic
benefit
is
any derivatives will also allow Sinus opacification shows on CT scans of ~90% with a cold and ~40%
commercial use. This is the without a cold, so useless for diagnosing "sinusitis," as are X-rays.16,86-88 The
license used by Wikipedia, and is recommended for
diagnosis is based on history. Precise criteria are controversial.57,89,90 The real
materials that would benefit question is: when will an antibacterial antibiotic help more than harm? (a)
from incorporating content onset with very severe symptoms or high fever for at least 3-4 days, or (b)
from Wikipedia and similarly licensed projects.
Set in Scala Sans and Minion in InDesign
worsening after 5-6 cough in kids) > 10 helps, even in kids,
days or days in but oral
(c) with ongoing nasal discharge (or daytime adults or >14 days in kids.91-93 Steroid nasal spray steroids are not recommended.16,93,94 Amoxicil-
This document may be lin, Bactrim and Zithromax no longer work due to resistant pneumococcus;
downloaded from
top choices are Augmentin, high-dose if high fever, daycare, age 65,
ftp recent hospitalization, antibiotics in the past month, or immunocompro-
mised (high-dose is 2 g BID for adults, 90 mg/kg/day for kids),
doxycycline, or Levaquin/Avelox90,93 but now with bad side
effects of quinolones like Levaquin/Avelox,95,96 cefdinir is now
second-line for kids and Ceftin is third-line for adults, both safe
with penicillin allergy.97 Those with bad nasal allergies also get
bacterial sinusitis.
1. Arroll B, Kenealy T. Antibiotics for
overdose associated with seizures and
LR, Soszynski D. The adaptive value of
the common cold and acute purulent
arrhythmias. J Toxicol Clin Toxicol
fever. Infectious disease clinics of North
rhinitis. Cochrane Database of Systematic 1998;36:713-8.
America 1996;10:1-20.
Reviews. Chichester, UK: John Wiley & 35. Cohen V, Jellinek SP, Stansfield L,
66. Camarena-Michel A. Fever in the
Sons, Ltd; 2005.
Truong H, Baseluos C, Marshall JP. Car- Emergency Department Predicts Survival
2. Douglas RGJ, Lindgren KM, Couch
diac arrest with residual blindness after of Patients with Severe Sepsis and Septic
RB. Exposure to cold environment and overdose of Tessalon(R) (benzonatate) Shock Admitted to the ICU. Journal of
rhinovirus common cold. Failure to dem- perles. J Emerg Med 2011;41:166-71.
Emergency Medicine;52:907-8.
onstrate effect. N Engl J Med 1968;279. 36. Winter ML, Spiller HA, Griffith JR. 67. Sharfstein JM, North M, Serwint JR.
3. Johnson C, Eccles R. Acute cooling of Benzonatate Ingestion Reported to the Over the counter but no longer under the
the feet and the onset of common cold National Poison Center Database System radar--pediatric cough and cold medica-
symptoms. Fam Pract 2005;22:608-13. (NPDS). J Med Toxicol 2010;6:398-402. tions. N Engl J Med 2007;357:2321-4.
4. Prather A, Janicki-Deverts D, Hall M, 37. McLawhorn MW, Goulding MR,
68. Shefrin AE, Goldman RD. Use of
Cohen S. Behaviorally Assessed Sleep
Gill RK, Michele TM. Analysis of
over-the-counter cough and cold medica-
and Susceptibility to the Common Cold. Benzonatate Overdoses Among Adults tions in children. Can Fam Physician
Sleep 2015.
and Children from 1969?2010 by the
2009;55:1081-3.
5. Smeeth L, Thomas SL, Hall AJ,
United States Food and Drug Administra- 69. Mossad SB. Treatment of the common
Hubbard R, Farrington P, Vallance P. tion. Pharmacotherapy: The Journal of cold. Bmj 1998;317:33-6.
Risk of Myocardial Infarction and Stroke Human Pharmacology and Drug Therapy 70. Jafek BW, Linschoten MR, Murrow
after Acute Infection or Vaccination.
2013;33:38-43.
BW. Anosmia after intranasal zinc gluco-
New England Journal of Medicine
38. Oduwole O, Udoh EE, Oyo-Ita A,
nate use. Am J Rhinol 2004;18:137-41.
2004;351:2611-8.
Meremikwu MM. Honey for acute cough 71. Singh M, Das RR. Zinc for the
6. Kwong JC, Schwartz KL, Campitelli
in children. Cochrane database of system- common cold. Cochrane Database of
MA, et al. Acute Myocardial Infarction atic reviews (Online) 2018;4:Cd007094. Systematic Reviews. Chichester, UK: John
after Laboratory-Confirmed Influenza 39. Sperber SJ, Hendley JO, Hayden FG, Wiley & Sons, Ltd; 2011.
Infection. N Engl J Med 2018;378:345-53. Riker DK, Sorrentino JV, Gwaltney JM, 72. Shang A, Huwiler-Muntener K,
7. Shakib JH, Korgenski K, Presson
Jr. Effects of naproxen on experimental Nartey L, et al. Are the clinical effects of
AP, et al. Influenza in Infants Born to
rhinovirus colds. A randomized, double- homoeopathy placebo effects? Compara-
Women Vaccinated During Pregnancy. blind, controlled trial. Annals of internal tive study of placebo-controlled trials
Pediatrics 2016.
medicine 1992;117:37-41.
of homoeopathy and allopathy. Lancet
8. Heikkinen T, Jarvinen A. The common 40. Kim SY, Chang YJ, Cho HM, Hwang 2005;366:726-32.
cold. Lancet 2003;361:51-9.
YW, Moon YS. Non-steroidal anti-
73. Reimann HA. Viral infections
9. Fleming DW, Cochi SL, Hightower AW, inflammatory drugs for the common cold. of respiratory tract; their treatment
Broome CV. Childhood upper respira- Cochrane database of systematic reviews and prevention. J Am Med Assoc
tory tract infections: to what degree is
(Online) 2015;9:CD006362.
1946;132:487-93.
incidence affected by day-care attendance? 41. Edwards DR, Aldridge T, Baird
74. Singh M, Singh M. Heated, humidified
Pediatrics 1987;79:55-60.
DD, Funk MJ, Savitz DA, Hartmann
air for the common cold. Cochrane Da-
10. Martineau AR, Jolliffe DA, Hooper KE. Periconceptional over-the-counter tabase of Systematic Reviews. Chichester,
RL, et al. Vitamin D supplementation to nonsteroidal anti-inflammatory drug ex- UK: John Wiley & Sons, Ltd; 2011.
prevent acute respiratory tract infections: posure and risk for spontaneous abortion. 75. Tyrrell D, Barrow I, Arthur J. Local
systematic review and meta-analysis of Obstet Gynecol 2012;120:113-22.
hyperthermia benefits natural and
individual participant data. BMJ 2017;356. 42. Ericson A, K?ll?n BA. Nonsteroidal experimental common colds. Bmj
11. Martineau AR, Jolliffe DA, Hooper anti-inflammatory drugs in early
1989;298:1280-3.
RL, et al. Vitamin D supplementation to pregnancy. Reproductive Toxicology
76. Linde K, Barrett B, Bauer R, Melchart
prevent acute respiratory tract infections: 2001;15:371-5.
D, Woelkart K. Echinacea for preventing
systematic review and meta-analysis
43. Nm J, Ms G. THe effects of im-
and treating the common cold. Cochrane
of individual participant data. BMJ
munosuppressive and anti-inflammatory Database of Systematic Reviews. Chiches-
2017;356:i6583.
medications on fertility, pregnancy, and ter, UK: John Wiley & Sons, Ltd; 2006.
12. Lee RJ, Xiong G, Kofonow JM, et al. lactation. Archives of Internal Medicine 77. Hemil? H, Chalker E, Douglas B.
T2R38 taste receptor polymorphisms un- 2000;160:610-9.
Vitamin C for preventing and treating
derlie susceptibility to upper respiratory 44. Janssen NM, Genta MS. The
the common cold. Cochrane Database of
infection. J Clin Invest 2012;122:4145-59. effects of immunosuppressive and anti- Systematic Reviews. Chichester, UK: John
13. LeRoy AS, Murdock KW, Jaremka LM, inflammatory medications on fertility, Wiley & Sons, Ltd; 2007.
Loya A, Fagundes CP. Loneliness Predicts pregnancy, and lactation. Arch Intern
78. Lissiman E, Bhasale Alice L, Cohen M.
Self-Reported Cold Symptoms After a
Med 2000;160:610-9.
Garlic for the common cold. Cochrane
Viral Challenge. Health Psychol 2017.
45. Nakhai-Pour HR, Broy P, Sheehy
Database of Systematic Reviews. Chiches-
14. Aronson MD, Weiss ST, Ben RL, Ko- O, B?rard A. Use of nonaspirin nonste- ter, UK: John Wiley & Sons, Ltd; 2009.
maroff AL. Association between cigarette roidal anti-inflammatory drugs during 79. Taylor EN, Stampfer MJ, Curhan GC.
smoking and acute respiratory tract illness pregnancy and the risk of spontaneous Dietary factors and the risk of incident
in young adults. Jama 1982;248:181-3.
abortion. Canadian Medical Association kidney stones in men: new insights after
15. Eccles R. Understanding the symp- Journal 2011;183:1713-20.
14 years of follow-up. J Am Soc Nephrol
toms of the common cold and influenza. 46. Katz J, Kargi AY, Ramasamy R. Re:
2004;15:3225-32.
Lancet Infect Dis 2005;5:718-25.
Ibuprofen Alters Human Testicular Physi- 80. Saketkhoo K, Januszkiewicz A,
16. Wald ER, Applegate KE, Bordley C, ology To Produce a State of Compensated Sackner MA. Effects of drinking hot
et al. Clinical Practice Guideline for the Hypogonadism. Eur Urol 2018.
water, cold water, and chicken soup on
Diagnosis and Management of Acute
47. Wen Y-C, Hsiao F-Y, Chan KA, Lin nasal mucus velocity and nasal airflow
Bacterial Sinusitis in Children Aged 1 to Z-F, Shen L-J, Fang C-C. Acute respira- resistance. Chest 1978;74:408-10.
18 Years. Pediatrics 2013.
tory infection and use of nonsteroidal
81. Rennard BO, Ertl RF, Gossman GL,
17. Mackowiak PA. Physiological rationale anti-inflammatory drugs on risk of acute Robbins RA, Rennard SI. Chicken soup
for suppression of fever. Clin Infect Dis myocardial infarction: a nationwide case- inhibits neutrophil chemotaxis in vitro.
2000;31 Suppl 5:S185-9.
crossover study. The Journal of infectious Chest 2000;118:1150-7.
18. Eyers S, Weatherall M, Shirtcliffe
diseases 2017;215:503-9.
82. Waljee AK, Rogers MA, Lin P, et al.
P, Perrin K, Beasley R. The effect on
48. Smucny J, Becker LA, Glazier R.
Short term use of oral corticosteroids and
mortality of antipyretics in the treatment Beta2-agonists for acute bronchitis.
related harms among adults in the United
of influenza infection: systematic review Cochrane Database of Systematic
States: population based cohort study.
and meta-analysis. Journal of the Royal Reviews. Chichester, UK: John Wiley & BMJ 2017;357:j1415.
Society of Medicine 2010;103:403-11.
Sons, Ltd; 2006.
83. Jefferson T, Jones MA, Doshi P,
19. Earn DJD, Andrews PW, Bolker BM. 49. Ebell MH, Lundgren J, Youngpairoj S. et al. Neuraminidase inhibitors for
Population-level effects of suppressing How long does a cough last? Comparing preventing and treating influenza in
fever. Proceedings of the Royal Society B: patients' expectations with data from a healthy adults and children. Cochrane
Biological Sciences 2014;281.
systematic review of the literature. Annals database of systematic reviews (Online)
20. Drexler JF, Helmer A, Kirberg H, et al. of family medicine 2013;11:5-13.
2012;1:CD008965.
Poor clinical sensitivity of rapid antigen 50. Taverner D, Latte GJ. Nasal deconges- 84. Lee GM, Friedman JF, Ross-Degnan
test for influenza A pandemic (H1N1) tants for the common cold. Cochrane Da- D, Hibberd PL, Goldmann DA. Mis-
2009 virus. Emerging infectious diseases tabase of Systematic Reviews. Chichester, conceptions about colds and predictors
2009;15:1662-4.
UK: John Wiley & Sons, Ltd; 2009.
of health service utilization. Pediatrics
21. Fader RC. Comparison of the Binax 51. Hatton RC, Hendeles L. Over-the-
2003;111:231-6.
NOW Flu A enzyme immunochromato- Counter Oral Phenylephrine: A Placebo 85. Mainous AG, 3rd, Hueston WJ, Clark
graphic assay and R-Mix shell vial culture for Nasal Congestion. The journal of al- JR. Antibiotics and upper respiratory
for the 2003-2004 influenza season. J Clin lergy and clinical immunology In practice infection: do some folks think there is a
Microbiol 2005;43:6133-5.
2015;3:709-10.
cure for the common cold. The Journal of
22. Landry ML, Cohen S, Ferguson D.
52. Winther B, Buchert D, Turner RB,
family practice 1996;42:357-61.
Comparison of Binax NOW and Directi- Hendley JO, Tschaikin M. Decreased
86. Kaiser L, Lew D, Hirschel B, et al.
gen for rapid detection of influenza A and rhinovirus shedding after intranasal
Effects of antibiotic treatment in the
B. J Clin Virol 2004;31:113-5.
oxymetazoline application in adults
subset of common-cold patients who have
23. Rahman M, Vandermause MF, Kieke with induced colds compared with
bacteria in nasopharyngeal secretions.
BA, Belongia EA. Performance of Binax intranasal saline. Am J Rhinol Allergy
Lancet 1996;347:1507-10.
NOW Flu A and B and direct fluorescent 2010;24:374-7.
87. Schwartz RH, Pitkaranta A, Winther
assay in comparison with a composite
53. Eccles R, Martensson K, Chen SC.
B. Computed tomography imaging of the
of viral culture or reverse transcription Effects of intranasal xylometazoline, alone maxillary and ethmoid sinuses in children
polymerase chain reaction for detection or in combination with ipratropium, in with short-duration purulent rhinorrhea.
of influenza infection during the 2006 to patients with common cold. Curr Med Otolaryngology--head and neck surgery :
2007 season. Diagn Microbiol Infect Dis Res Opin 2010.
official journal of American Academy of
2008;62:162-6.
54. Puhakka T, Makela MJ, Malmstrom Otolaryngology-Head and Neck Surgery
24. Smit M, Beynon KA, Murdoch DR, K, et al. The common cold: effects of intra- 2001;124:160-3.
Jennings LC. Comparison of the NOW nasal fluticasone propionate treatment. J 88. Gwaltney JM, Jr., Phillips CD, Miller
Influenza A & B, NOW Flu A, NOW Flu Allergy Clin Immunol 1998;101:726-31. RD, Riker DK. Computed tomographic
B, and Directigen Flu A+B assays, and 55. Intranasal steroids alone effective for study of the common cold. The New Eng-
immunofluorescence with viral culture acute uncomplicated sinusitis. The Journal land journal of medicine 1994;330:25-30.
for the detection of influenza A and
of family practice 2006;55:190.
89. Lanza DC, Kennedy DW. Adult
B viruses. Diagn Microbiol Infect Dis
56. Zalmanovici A, Yaphe J. Intranasal rhinosinusitis defined. Otolaryngology-
2007;57:67-70.
steroids for acute sinusitis. Cochrane
-head and neck surgery : official journal of
25. Pratter MR. Cough and the common database of systematic reviews (Online) American Academy of Otolaryngology-
cold: ACCP evidence-based clinical prac- 2009:CD005149.
Head and Neck Surgery 1997;117:S1-7.
tice guidelines. Chest 2006;129:72S-4S. 57. Williamson IG, Rumsby K, Benge S, 90. Garbutt JM, Banister C, Spitznagel
26. Croughan-Minihane MS, Petitti DB, et al. Antibiotics and topical nasal steroid E, Piccirillo JF. Amoxicillin for acute
Rodnick JE, Eliaser G. Clinical trial exam- for treatment of acute maxillary sinusitis: rhinosinusitis: a randomized controlled
ining effectiveness of three cough syrups. J a randomized controlled trial. JAMA
trial. Jama 2012;307:685-92.
Am Board Fam Pract 1993;6:109-15.
2007;298:2487-96.
91. Benninger MS, Sedory Holzer SE, Lau
27. Smith MB, Feldman W. Over-the-
58. Slapak I, Skoupa J, Strnad P, Hornik P. J. Diagnosis and treatment of uncom-
counter cold medications. A critical
Efficacy of isotonic nasal wash (seawater) plicated acute bacterial rhinosinusitis:
review of clinical trials between 1950 and in the treatment and prevention of rhinitis summary of the Agency for Health Care
1991. Jama 1993;269:2258-63.
in children. Arch Otolaryngol Head Neck Policy and Research evidence-based
28. Smith SM, Schroeder K, Fahey T.
Surg 2008;134:67-74.
report. Otolaryngology--head and neck
Over-the-counter (OTC) medications
59. Wang Y-H, Yang C-P, Ku M-S, Sun
surgery : official journal of American
for acute cough in children and adults in H-L, Lue K-H. Efficacy of nasal irrigation Academy of Otolaryngology-Head and
ambulatory settings. Cochrane Database in the treatment of acute sinusitis in chil- Neck Surgery 2000;122:1-7.
of Systematic Reviews. Chichester, UK: dren. International journal of pediatric 92. Ahovuo-Saloranta A, Rautakorpi
John Wiley & Sons, Ltd; 2008.
otorhinolaryngology 2009;73:1696-701. U-M, Borisenko OV, Liira H, Williams
29. Taylor JA, Novack AH, Almquist JR, 60. Rabago D, Zgierska A, Mundt M,
JJW, M?kel? M. Antibiotics for acute
Rogers JE. Efficacy of cough suppressants Barrett B, Bobula J, Maberry R. Efficacy maxillary sinusitis. Cochrane Database of
in children. J Pediatr 1993;122:799-802. of daily hypertonic saline nasal irrigation Systematic Reviews. Chichester, UK: John
30. Eccles R, Morris S, Jawad M. Lack
among patients with sinusitis: a random- Wiley & Sons, Ltd; 2008.
of effect of codeine in the treatment
ized controlled trial. The Journal of family 93. Chow AW, Benninger MS, Brook I,
of cough associated with acute upper
practice 2002;51:1049.
et al. IDSA Clinical Practice Guideline
respiratory tract infection. J Clin Pharm 61. Graham NM, Burrell CJ, Douglas RM, for Acute Bacterial Rhinosinusitis in
Ther 1992;17:175-80.
Debelle P, Davies L. Adverse effects of
Children and Adults. Clin Infect Dis
31. Paul IM, Beiler J, McMonagle A,
aspirin, acetaminophen, and ibuprofen 2012;54:e72-e112.
Shaffer ML, Duda L, Berlin CM, Jr.
on immune function, viral shedding, and 94. Venekamp RP, Thompson MJ,
Effect of honey, dextromethorphan, and clinical status in rhinovirus-infected vol- Hayward G, et al. Systemic cortico-
no treatment on nocturnal cough and
unteers. J Infect Dis 1990;162:1277-82. steroids for acute sinusitis. Cochrane
sleep quality for coughing children and 62. McBride JT. The association of acet- database of systematic reviews (Online)
their parents. Arch Pediatr Adolesc Med aminophen and asthma prevalence and 2011:CD008115.
2007;161:1140-6.
severity. Pediatrics 2011;128:1181-5.
95. Daneman N, Lu H, Redelmeier DA.
32. Paul IM, Yoder KE, Crowell KR, et
63. Sheehan WJ, Mauger DT, Paul IM,
Fluoroquinolones and collagen associated
al. Effect of dextromethorphan, diphen- et al. Acetaminophen versus Ibuprofen severe adverse events: a longitudinal
hydramine, and placebo on nocturnal
in Young Children with Mild Persistent cohort study. BMJ Open 2015;5:e010077.
cough and sleep quality for coughing
Asthma. New England Journal of
96. Lee CC, Lee MT, Chen YS, et al.
children and their parents. Pediatrics
Medicine 2016;375:619-30.
Risk of Aortic Dissection and Aortic
2004;114:e85-90.
64. Kim Sy, Chang Y-J, Cho HM,
Aneurysm in Patients Taking Oral Fluo-
33. Freestone C, Eccles R. Assessment
Hwang Y-w, Moon YS. Non-steroidal
roquinolone. JAMA internal medicine
of the antitussive efficacy of codeine in anti-inflammatory drugs for the common 2015;175:1839-47.
cough associated with common cold. J cold. Cochrane Database of Systematic 97. Pichichero ME, Casey JR. Safe use of
Pharm Pharmacol 1997;49:1045-9.
Reviews. Chichester, UK: John Wiley & selected cephalosporins in penicillin-aller-
34. Crouch BI, Knick KA, Crouch DJ,
Sons, Ltd; 2009.
gic patients: a meta-analysis. Otolaryngol
Matsumura KS, Rollins DE. Benzonatate 65. Kluger MJ, Kozak W, Conn CA, Leon Head Neck Surg 2007;136:340-7.
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