Evidence-based Upper Respiratory Infection Prescription

Common cold is the most frequent illness encountered in general practice. Several viruses can cause common cold, but rhinoviruses are by far most common. Treatments have included symptomatic measures, pharmacological blockers, and specific antiviral agents, as well as drugs with yet unestablished mechanism of action. A systematic, evidence-based assessment based on the relevant literature is imperative for rational selection of treatment modality for patients with a common cold. Alleviation of symptoms remains the only proved way to manage common cold. First generation antihistamines, anticholinergics, and agonists effectively reduce rhinorrhea and sneezing but have minimal effects on other symptoms. Antitussive agents are probably of minimal benefit. Over-the-counter cold treatments are effective only in adults and adolescents. Antiviral drugs such as interferon alfa-2b are effective only if taken before symptoms develop. Primary care physicians need to identify those patients with acute pharyngitis who require specific antimicrobial therapy and to avoid unnecessary and potentially deleterious treatment. In most cases, differentiation between these two types of infection can be accomplished easily if the physician considers the epidemiologic setting, the history, and the physical findings, plus the results of a few readily available laboratory tests. When antimicrobial therapy is required, the safest, narrowest-spectrum, and most cost-effective drugs should be used.