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There Is No Cure for the Common Cold
Abstract & Commentary
By John P. Santamaria, MD, Affiliate Professor of Pediatrics, University of South Florida School of Medicine, Tampa, FL, is Associate Editor for Urgent Care Alert.
Dr. Santamaria reports no financial relationships relevant to this field of study.
Synopsis: Despite the fact that cold remedies are not proven to be effective, and that some safety issues are associated with their use in the pediatric age group, physicians still recommend them.
Source: Cohen-Kerem R, et al. The attitude of physicians toward cold remedies for upper respiratory infection in infants and children: A questionnaire survey. Clin Pediatr (Phila). 2006;45:828-834.
Over-the-counter cold medications are widely available and commonly used in infants and children. Cohen-Kerem and colleagues present a brief review of the literature, reminding us that critical reviews generally fail to demonstrate a beneficial effect over placebo in the relief of cough and cold symptoms in children, particularly for preschoolers and infants. The goal of this article was to query a random sample of Canadian family practitioners and pediatricians and study the attitudes of these physicians toward the use of cold remedies in infants and children. Of those sent questionnaires, 266 physicians (53.2%) responded. Overall, many respondents were willing to recommend over-the-counter cold remedies to young children; 50.6% for 1 to 3-year-olds, 30.1% for 6 to 12-month-olds, and 12.7% for 0 to 6-month-olds. Pediatricians and university-affiliated physicians were less willing to recommend these medications to children than family practitioners.
Reasons given for these recommendations included the need to treat the parent who is anxious and will procure the medications even if not recommended by the physician. Cohen-Kerem et al conclude that cold remedies are not of proven effectiveness and may have associated safety issues, yet they are still recommended by physicians. They suggest implementing medical education programs, practice guidelines, and policy statements to prevent the use of cold remedies in infants.
Cohen-Kerem et al provide a cogent argument against the use of cough and cold preparations in small children. Efficacy data lacking, these medications are a multi-billion dollar industry in the United States, a significant portion being spent on pediatric formulations. Significant side effects may be associated with the use of cough and cold medication in small children. In particular, combination cold and cough medications are not innocuous and their use in infants is ill-advised. Instead, increasing fluid intake, positioning, bulb suction of the nose, and parent education should be attempted. If a cough and cold medication is deemed necessary by the physician, the use of a single-ingredient medication is recommended. Since many untoward effects of these drugs are a result of improper administration, clear instructions should be given for their use, especially when used in infants for whom no dosing schedule is provided by the manufacturer.