Patient Education/Home Care Call Back Instructions
Key Points:
- It is recommended that patients, parents and caregivers be educated on prevention, comfort measures, and treatment recommendations for the common cold.
- Patients with a viral illness may be aware of measures to relieve symptoms and reduce spread of infection. It is important to provide them with practical, preferably evidence-based, advice.
Prevention
Although the viral upper respiratory infection is a respiratory illness, researchers have found that viral upper respiratory infections are spread more by hands of the person with a cold and by very close contact than by droplets in the air. Hand washing is the most effective way to prevent the spread of the common cold (viral upper respiratory infection). Viral upper respiratory infection is most contagious at the onset of symptoms and while febrile [A].
For infants and toddlers:
- Discourage visitors who have an acute illness, a fever, or contagious disease.
- Prevent child with viral upper respiratory infection from sharing toys and pacifier with other children and clean these items with soap and hot water as feasible to reduce opportunities for viral transmission.
- Use and teach good hand washing.
- Ask visitors to wash their hands before holding baby.
- Daycare with three or more families represented is associated with higher incidence of viral upper respiratory infection, ear infections, and lower respiratory infections, therefore:
- Check to see if staff and children at your child's daycare are being taught good hand washing and other infection control measures (excellent educational materials are available that daycare providers can obtain).
- Consider daycare options that reduce exposure to other children
- Relative or friend
- In-home nanny shared by two families
- Because human milk contains ingredients that help protect babies from infections, encourage and support mothers to continue breast-feeding for an appropriate period.
Refer to the original guideline document for information about comfort measures for infants/children and adults/adolescents.
Treatment Recommendations
Antibiotics
Antibiotics are effective only for treating bacterial infections. Because colds are viral infections, antibiotic use will not cure or shorten their length [R].
Antibiotics cause side effects such as gastrointestinal discomfort, diarrhea, allergic reactions, diaper rash, and yeast infections. Unnecessary use of antibiotics can lead to the development of antibiotic-resistant strains of bacteria.
Over-the-Counter Medications
Over-the-counter cold and cough medications and acetaminophen do not shorten the duration of viral upper respiratory infection.
Children
In April 2007 the Food and Drug Administration issued a warning on using cough and cold medicines in young children. Parents and other caregivers should only administer cough and cold medications to children under two when following the exact advice of their doctor. Clinicians should be certain that caregivers understand both the importance of administering these medications only as directed and the risk of overdose if they administer additional medications that might contain the same ingredient [R].
The Food and Drug Administration does not have approved dosing recommendations for clinicians prescribing cough and cold medications for children two and under [R].
Because of the risk of Reye's syndrome associated with aspirin use in children, acetaminophen should be suggested as the drug of choice for home use.
The fever that frequently accompanies a viral upper respiratory infection in children is not harmful and is usually gone in two to three days. It is the consensus of the work group that fevers persisting beyond that time should be evaluated by a provider. Work group members also agree that infants under three months with fevers should be thoroughly evaluated [R].
Adults
For adults with a cold, over-the-counter products such as nasal sprays, decongestants, and analgesics may provide temporary relief of sore throat, runny nose, coughing, minor aches, and fever. Because of potential side effects, however, be sure to follow the recommended dosage and precautions. Patients who have high blood pressure, diabetes, thyroid disease or, who are pregnant should check with their physician regarding recommendations for decongestant use.
Use medication for discomfort as recommended by a physician or nurse for fever.
General Discomfort, Headache, and Fever Reduction
Aspirin, ibuprofen and naproxen should be avoided by persons who 1) are not eating well (risk of gastrointestinal bleeding); 2) have a history of peptic ulcer or related disorder; 3) have aspirin-sensitive asthma; and 4) have renal dysfunction. For these reasons, plus the risk of Reye's syndrome associated with aspirin use in young, healthy adults, acetaminophen should be suggested as the drug of choice. However, it should be used only as needed because of adverse effects.
In the adolescent/adult studies, the following drugs were found to reduce nasal symptoms: chlorpheniramine maleate (e.g., Chlor-Trimeton®), pseudoephedrine HCl (e.g., Sudafed®), and oxymetazoline HCl (e.g., Afrin®) [M].
Atrovent is not effective when there is documented significant nasal obstruction. The cost/benefit relationship for Atrovent Nasal Spray is rarely supportive for use of this medication. In addition, it requires physician intervention that consists of phone calls and/or office visits, which significantly increase the cost of care for a benign condition.
Echinacea
Findings in the medical literature do not support the use of echinacea in preventing viral upper respiratory infection. Some preliminary data indicate that echinacea may shorten the course of viral upper respiratory infection; however, studies that produced this data are small. Methods by which echinacea is prepared are not standardized, and actual dose delivered by specific products varies widely. Hence, the work group cannot recommend the use of echinacea in preventing or shortening the duration of viral upper respiratory infection at this time. The work group will continue to evaluate the data on this and other herbal preparations [A, B].
Vitamin C
There is no consistent evidence in the medical literature that high doses of vitamin C help shorten the course of viral upper respiratory infections. Hence, it was the consensus of the work group that high doses of vitamin C should not be recommended.
Zinc
In adults there is some evidence that zinc gluconate may decrease the duration of a cold if started within 24 hours of onset; however, adverse reactions including nausea and bad taste may limit its usefulness. Zinc is not indicated and may be dangerous during pregnancy.
According to the Cochrane Collaborative, overall results of studies of the effect of zinc gluconate on upper-respiratory infection duration and severity have been inconclusive [M].
Refer to the original guideline document for additional information on zinc.
Call Back Instructions
Children three months to 18 years of age
Call back if:
- Fever lasts three days or more
- Symptoms worsen after 3 to 5 days or if new symptoms appear (e.g., increasing symptoms of illness, lethargy, decreased responsiveness, poor eye contact, difficulty breathing)
- Symptoms have not improved after 7 to 10 days; it is not unusual, however, for a mild cough and congestion to continue 14 days or more
Adults
Call back if symptoms worsen after three to five days, new symptoms develop or symptoms do not improve after 14 days.