What to order for viral cold symptoms?

From the Guidelines

For viral cold symptoms, I recommend ordering oseltamivir (Tamiflu) as the first line of treatment, as it has been shown to reduce the duration of illness by 17.6 hours in children with laboratory-confirmed influenza 1.

Treatment Options

• Oseltamivir is available in capsule and oral suspension formulations, with dosages varying based on age and weight, as outlined in the table below:

  Medication	Treatment
  Oseltamivir	Adults 75 mg, twice daily for 5 d; Children ≥12 mo (based on body wt) 30-75 mg, twice daily for 5 d

• The duration of treatment with oseltamivir is 5 d, and it should be started as soon as possible after illness onset, without waiting for a definitive influenza test result 1.

Important Considerations

• Clinical judgment is crucial in treatment decisions for pediatric patients with influenzalike illness, taking into account underlying conditions, disease severity, time since symptom onset, and local influenza activity 1.
• Antiviral treatment should not be delayed, as early therapy provides the best outcomes, and the benefits of oseltamivir treatment are likely to outweigh the risks, even in the absence of definitive influenza test results 1.
• Influenza diagnostic tests vary by method, availability, processing time, sensitivity, and cost, and should be considered in making the best clinical decision 1.

Additional Recommendations

• Stay hydrated by drinking plenty of fluids, use saline nasal sprays to moisturize nasal passages, and consider using a humidifier to help alleviate symptoms.
• Rest is essential for recovery, and most viral colds resolve within 7-10 days, but contact a healthcare provider if symptoms worsen or persist beyond two weeks, or if you develop high fever, severe headache, or difficulty breathing.

From the FDA Drug Label

The efficacy of oseltamivir phosphate in preventing naturally occurring influenza illness has been demonstrated in three seasonal prophylaxis (community outbreak) clinical trials and one post-exposure prophylaxis trial in household contacts The efficacy endpoint for all of these trials was the incidence of laboratory-confirmed clinical influenza defined as meeting all the following criteria (all signs and symptoms must have been recorded within 24 hours): oral temperature greater than or equal to 99.0ºF (37. 2ºC), at least one respiratory symptom (cough, sore throat, nasal congestion), at least one constitutional symptom (aches and pain, fatigue, headache, chills/sweats), and either a positive virus isolation or a four-fold increase in virus antibody titers from baseline Oseltamivir phosphate treatment of 2 mg per kg twice daily, started within 48 hours of onset of symptoms, reduced the total composite time to freedom from illness by 1. 5 days compared to placebo.

For viral cold symptoms, the recommended order is oseltamivir phosphate.

• The dosage for adults and adolescents (13 years of age and older) is 75 mg once daily.
• The dosage for pediatric subjects (1 year to 12 years of age) is 30 to 60 mg taken orally once daily.
• The treatment duration is 5 days for treatment and 7 to 10 days for prophylaxis. 2 2

From the Research

Viral Cold Symptoms

To manage viral cold symptoms, consider the following options:

• Over-the-counter analgesics to relieve pain and reduce fever 3
• Zinc to help alleviate symptoms 3
• Nasal decongestants with or without antihistamines to relieve nasal congestion 4, 3
• Ipratropium to relieve cough and nasal symptoms 4, 3
• Honey (for children one year and older) to soothe a cough 3
• Nasal saline irrigation to relieve nasal congestion 3
• Topical application of ointment containing camphor, menthol, and eucalyptus oils to relieve cough and nasal symptoms 3

Important Considerations

• Antibiotics are not effective against viral colds and should not be used 4, 3
• Over-the-counter cold medications should not be used in children younger than four years 3
• It is essential to read and follow the package labeling for appropriate dosing and administration of over-the-counter medications 5
• Patients should be educated about available over-the-counter medications and their potential side effects 5

Additional Options

• Lactobacillus casei may be beneficial in older adults, although the evidence is limited 3
• Acetylcysteine may be effective in children, but more research is needed to confirm its efficacy 3
• Oseltamivir, an antiviral medication, may be effective in reducing the duration and severity of influenza symptoms, but its use should be weighed against potential side effects 6