Home' Australian Pharmacist : May 2011 Contents Vol. 30 -- May #05
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
Are there any 'natural'
medicines that are effective?
Complementary medicines which
have been used for the common cold
include echinacea, vitamin C and zinc.
Each of these has been the subject of
a Cochrane review.
A Cochrane review on echinacea
found no clear evidence of benefit in
children for either the prevention or
the treatment of the common cold.
There were few adverse effects,
although rashes were reported in
one trial in children.27
A Cochrane review of vitamin C found
no trials investigating vitamin C for
the treatment of the common cold in
children. However, results of trials on
regular prophylactic supplementation
found a reduction in symptom duration
of 13% in children (and 8% in adults).
The authors estimated that long-term
prophylaxis might produce an average
reduction in four symptom days (from
28 to 24 days) per year per child.
In addition, one of the prophylactic
studies found that, in children, 2 g/day
produced about twice the benefit
of 1 g/day. None of the trials found
evidence that vitamin C might be
harmful in the doses that were tested.
The review authors recommend further
trials be carried out to test the benefits
of therapeutic supplementation in
children, using doses of at least
2 g per day.28
A recently updated Cochrane review
found that zinc, when administered
within 24 hours of onset of symptoms,
reduced the duration and severity
of the common cold. When children
were given zinc supplements for at
least five months, they had reduced
cold incidence, school absenteeism
and prescriptions for antibiotics.
However, zinc lozenges (but not syrup
or tablets) produced adverse effects,
including bad taste and nausea. The
reviewers concluded that, in view of
the differences in study populations,
dosages, formulations and duration of
treatment, more research is needed
before a definitive recommendation
can be made.29
Is there anything else I can
do to help?
The following strategies may help to
relieve cold symptoms:2,6,30,31
• To avoid dehydration, encourage
the child to drink plenty of fluids.
Frequent, small drinks may be
easier for the child to manage.
• Saline nasal spray or drops (e.g.
Fess, Narium) may help to relieve
nasal congestion while avoiding the
risk of rebound congestion from use
of a topical nasal decongestant.
• Steam inhalations may help clear
mucus and relieve blocked sinuses.
Children should only inhale steam
from a shower, as steam from a
bowl of hot water can burn the
lining of a child's nose.
• Paracetamol can be given in
appropriate doses if the child has a
sore throat or fever. Ibuprofen may
be an alternative for children over
six months of age. Aspirin should
not be given to children under 18
years of age due to the risk of
• Avoid exposing the child to cigarette
Should I take my child to
If children develop any of the following
symptoms they should be taken to
the doctor: a temperature >38.5oC;
chills; a stiff neck; severe headache;
photophobia; chest pain; a skin rash;
a persistent cough; fast or noisy
breathing or difficulty breathing;
vomiting; pale or mottled skin; unusual
drowsiness; or earache. Additional
triggers for referral in a baby include
bulging of the fontanelle; a strange,
high-pitched cry; irritability or lethargy;
and refusal to feed.2,31,32
Mrs Tait can be reassured that a child
of Jimmy's age can get as many as
12 colds a year, but that the colds
should decrease in frequency as he
gets older. Jimmy's symptoms are
consistent with a common cold but,
if he develops any of the 'alarm'
symptoms listed above, or if his
symptoms show no improvement
within the next two or three days,
she should take him to the doctor.
Because the common cold is caused
by a virus, antibiotics will be of
no benefit. In addition, because
there is insufficient evidence that
cough and cold medicines or herbal
medicines are effective in children,
but may cause adverse effects, it is
preferable not to use them. Mrs Tait
can give Jimmy some paracetamol
syrup (at an appropriate dose for
his age and weight) to relieve fever
and sore throat. Saline nose drops
may also be used to help clear his
Key learning points
The common cold can be caused by
more than 200 different viruses. Colds
are most commonly acquired through
direct hand contact, with inhalation of
infected droplets being a less common
mode of transmission. Cold symptoms
include a sore throat, sneezing,
rhinorrhoea, nasal congestion and
a non-productive cough which may
later become loose and productive.
Most symptoms resolve within four
to 10 days, although cough may
persist for up to three weeks. There
is currently little evidence that cough
and cold medicines are effective in
children. The TGA has determined that
these medicines should not be used
in children under two years of age.
They have also recommended that
these medicines should not be used
in children under six years of age, and
should only be given to children aged
6--12 years on the advice of a doctor
or pharmacist. Paracetamol and saline
nasal drops or spray may help to
relieve some cold symptoms in a child.
1. Medicines and Healthcare products Regulatory Agency
(MHRA). Overview -- risk : benefit of OTC cough and
cold medicines in children [online]. At: www.mhra.gov.
2. Coughs and Colds in Children. Patient UK information
leaflet [online]. At: www.patient.co.uk/health/Coughs-
3. Pray, WS. Nonprescription product therapeutics. 2nd
edn. Lippincott Williams & Wilkins; 2006.
4. Therapeutic Goods Administration. Review of cough
and cold medicines in children [online]. Apr 2009.
Australian Government, Department of Health and
Ageing. At: www.tga.gov.au/npmeds/consult/drlp-
5. Sweetman S, ed. Martindale: The Complete Drug
Reference. 36th edn. London: Pharmaceutical Press;
6. National Prescribing Service. NPS News 63:
Managing expectations for antibiotics in respiratory
tract infections [online]. At: www.nps.org.au/
7. Merck Manual for Healthcare Professionals [online]. At:
8. I nfluenza: a guide for pharmacists [online]. The Influenza
Specialist Group: Richmond Vic; 2006. At: www.
9. Smith SM, Schroeder K, Fahey T. Over-the-counter
(OTC) medications for acute cough in children and
adults in ambulatory settings. In: Cochrane Database of
counselling in practice
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