1. 1 Common cold

2. 2 Background Heikkinen T and Järvinen A. Lancet 2003;361:51–59. Viral cause : rhinoviruses 30–50%, coronaviruses 10–15%, influenza viruses 5 – 15%, RSV 5%, parainfluenza viruses 5% Youngest children 6 – 8 colds per year, adults 2 – 4 Seasonality Infection transmission : –Dose-dependant viral “innoculation” load: - hand contact, direct hit large particle aerosols, lingering small particle aerosols –Rhinovirus incubation period 10–12h, influenza 1–7 days

3. 3 http://www.idinchildren.com Source: Gwaltney JM. JAMA. 1967;202:494-498.

4. 4 To treat a cold? Cochrane reviews ( Arroll B, Kenealy T. Issue 3 2005) and Clinical Evidence (Arrol B. Search date May 2005) Antibiotics: No evidence of benefit, at expense of evidence of side effects Decongestants: Single dose relieves symptoms in adults, no evidence that repeated use helps. Not recommended in children Antihistamines: Inconclusive Vitamin C: No evidence that it prevents cold, some evidence, in high dose that it relieves duration by about 0.5 day. Zinc: Inconclusive (harm?) Heat, humidified air: Inconclusive – some risks Echinacea - Poor quality studies. 3 recent better RCTs all negative

5. 5 Paracetamol or ibuprofen for children? Arch Pediatr Adolesc Med; 2004; 158: 521 – 526. Meta analysis : 17 RCTs in total Pain relief (3 RCTs, 186 children) no difference Fever reduction favoured ibuprofen (9 RCTs, 1078 children) at 2, 4 and 6 hours Safety data showed no difference

6. 6 Common cold - Summary The common cold is viral in origin and, therefore, antibiotics are of little benefit at the expense of known side effects Symptoms of the cold can last 2 weeks or more. Explanation of this and patient reassurance are important in patient management Paracetamol or ibuprofen may be useful to relieve symptoms of pain