Colds and Sinus

At one time or another, patients have blamed almost all discomforts of the head and neck on "Sinus". However, the term "Sinus" means a bony cavity next to the nasal passageway and its medical usage should be reserved for conditions involving this structure. It is a location not a medical condition. A "Cold" refers to an infection of the nose and throat. It is usually viral but may also be caused by a bacteria. Usually, patients with colds are febrile, have malaise (feels sick) and myalgias (sore muscles).

      Types of Over-The-Counter Medications       List Of Over-The-Counter Medications

The Nonprescription Drugs Advisory Committee of the Federal Drug Authority (FDA) has issued a warning against using cold and sinus medications in young children and children under two years of age. Specifically:

Do not give cough medicine to children under 2 years of age.

Too much medicine may cause serious life threatening side effects.

Over dosage can occur if two medicines have the same type of ingredients.

Cold and cough medicines only treat the symptoms of the common cold they do not cure the cold. The child will get better with time.

For more information go to: http://www.fda.gov/cder/drug/advisory/cough_cold.htm

FDA reaffirmed the above statements plus stated cold and sinus medications containing one or more of the following ingredients: decongestants, expectorants, antihistamines and antitussives. These medications were found not to be effective in children under the age of 6 years and the safety of there use in this age group had not been established. See Fox News: http://www.foxnews.com/story/0,2933,303616,00.html

Most often the common "Cold" is caused by a virus. If so, the best treatment is often fluids, rest, and supportive over-the-counter medications. The problem with treating a "Cold" is it may not be a "Cold" at all. If symptoms do not improve in 5 to 7 days or if they worsen, a more serious condition may be present and reconsultation with a medical professional should be recommended. A simple sore or scratchy throat may be caused by a bacterial such as Group A Beta Hemolytic Streptococcus. If not treated, it may lead to rheumatic fever (disease of the heart valve ). Because of the emerging problem with bacterial resistance to antibiotics, patients should not be treated indiscriminately.

Antibiotic therapy should be reserved for patients in whom acute sinusitis ( infection of the sinuses ) is a consideration and for those with positive Strep Screens. Unfortunately, there is not a reliable way to tell a bacterial from a viral sinus infection. The physician has to use his judgment. View Abstract

The American Academy of Otolaryngology - Head and Neck Surgery, on September 2007, published guidelines for the treatment of rhinitis and bacterial sinusitis. Rhinosinusitis affects 31 million patients in the United States each year. The vast majority of these infections are caused by virus and antibiotics are not effective. The common cold falls into this category. Clinicians need to distinguish between bacterial and viral infections. A diagnosis of a bacterial infection should be suspected if:

Symptoms of acute rhinosinusitis are present for 10 or more days.

Symptoms worsen within 10 days after an initial improvement.

Patients with chronic or recurrent acute rhinosinusitis need to be evaluated for associated illness and additional studies need to be obtained.

If the physician decides to treat the patient, amoxicillin should be used in most non-penicillin allergic patient.

For more information go to: Rosenfeld RM et al. Clinical practice Guideline: Adult Sinusitis Otolaryngology-- Head and Neck Surgery 137,S1-S31, 2007

The organisms which cause acute sinusitis are the same as those that cause acute otitis media (middle ear infection). (In some respects, the ear can be thought of as a specialized sinus cavity.) However a major difference between the treatment of a bacterial infection of the sinuses and otitis media (middle ear infection) is the duration of treatment. Bacterial sinusitis is, especially if chronic, is treated for three weeks as an otitis media (middle ear infection) is usually treated for 10 days (sometimes even less). In 2004, the American Academy of Otolaryngology and head and neck surgery for antibiotic treatment of acute bacterial rhinosinusitis are: (NOTE: These recommendations may change and as with any recommendation may be out of date by the time of publication. Thus, always consult your physician or health care provider.)

If no recent antibiotics given in last 4 to 6 weeks and the patient is NOT allergic to penicillin

Amoxicillin/Clavulanate (Augmentin), Amoxicillin, Cefpodoxime proxetil (Vantin), Cefuroxime axetil (Ceftin) and Cefdinir (Omnicef)

If no recent antibiotics given in last 4 to 6 weeks and the patient IS allergic to penicillin

TMP/SMX (Septra), Azithromyxin (zithromax), Clarithromyxin (Biaxin), and Erythromycin

If recent antibiotics given in last 4 to 6 weeks and the patient is NOT allergic to penicillin

Amoxicillin/Clavulanate (Augmentin), Ceftriaxone (Rocefin)

If recent antibiotics given in last 4 to 6 weeks and the patient IS allergic to penicillin

TMP/SMX (Septra), Azithromyxin (zithromax), Clarithromyxin (Biaxin), Erythromycin, and Clindamycin.

NOTE: Zithromax and Biaxin are not recommended unless the patient is allergic to penicillin. As of Jan 2004 these antibiotics have a failure rate up to 25%.

Patient Suggestion: Ask your doctor if a generic medication may be able to treat your condition at a lower cost. For example:

A discount pharmacy was consulted on Nov 20, 2007 (prices used in this example may change and vary).
1) A 10 day supply of Augmentin XR taken two tablets twice a day for 10 days cost $139.94.   A similar dosage can be obtained by taking generic Augmentin 875 mg every twelve hours alternating with Amoxicillin 1000 mg every twelve hours. These dosages are alternated every size hours. Thus, a total of four doses of antibiotics are taken each day. Augmentin 875, Amoxicillin, Augmentin 875 and Amoxicillin. The total cost of this medication regiment is $66.98 a savings of $72.96.

Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis 2004
Otolaryngology-Head and Neck Surgery, Supplement 1, Vol. 130 No. 1 Jan 2004

Medial Management of Acute Bacterial Sinusitis Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis. Annals of Otology, Rhinology and Laryngology, 2000

Unilateral sinusitis is a "Red Flag" and all patients should be evaluated for a foreign body and neoplasm. Patients at high risk for developing nasal carcinoma (cancer) are those who smoke, are woodworkers, or are exposed to other carcinogens ( chemicals causing cancer).

If a "Cold" is associated with throat discomfort a health care professional may obtain a throat culture or screen for Streptococcus Pneumonia or "Strep". If a positive result is obtained the patient should be placed on an antibiotic in order to prevent Rheumatic Fever, a serious heart condition. Often a "Cold" is caused by a virus. If so, the best treatment is often fluids, rest, and supportive over-the-counter medications. If symptoms last for more than 2 weeks, a more serious condition may be present and reconsultation with a medical professional should be obtained.

Types of over-the-counter drugs used in the treatment of colds
(to be used under the guidance of your doctor)

#1. Decongestant: These medications open the nasal passages. They do so by constricting blood vessels. These medications can relieve airway obstruction, pressure symptoms and help the sinuses to drain. Unfortunately, they all may elevate blood pressure, cause a more rapid heart beat, cause more irregular heartbeats and cause insomnia. They should not be taken if you have high blood pressure, a heart condition, diabetes or insomnia. Decongestants can raise blood pressure and increase the heart rate. In diabetics, they can decrease insulin requirements which can lead to life threatening low blood sugar. In addition, these drugs may cause dangerous reactions if you are on MAO inhibitors or anti-Parkinson medications. Search PubMed for Nasal Decongestants

Decongestant nose sprays are also available and should only be used for 3 days and only 2 to 4 times a day or addiction can occur. When addicted, a condition called rhinitis medicamentosa occurs. This condition produces only a short period of relief with use of the nose spray and severe nasal symptoms when the nose spray is not use. It is very difficult to treat and difficult to withdraw the patient from the nose spray.

Most common over-the-counter nose sprays are: Afrin (Oxymetazoline HCL), Neosynephrine (Phenylephrine HCL) and Dristan (Phenylephrine HCL and Pheniramine Maleate).

Alert!! Decongestants containing phenylpropanolamine have been recalled by the FDA because of potential adverse effects on the cardio-vascular system, with the potential to cause heart attacks, high blood pressure and strokes. Common over-the-counter medications which contain phenylpropanolamine are : Travist-D, Triaminic Products, Dimetapp Products, Alka-Seltzer "Cold" products and Contact Products. Note: Not all dimetapp and triaminic products contain phenylpropanolamine.

#2. Cough Medication: Contained in some of the "Cold" preparations. Some may be addicting and cause drowsiness.

#3. Pain Medication: Most products with an analgesic or pain medication use Acetaminophen or Tylenol. These medications not only relieve pain but also will help reduce a fever. A few use Ibuprofen (Advil Cold and Sinus) which is a drug similar to aspirin, and should not be used in aspirin sensitive patients. Many "Cold" and "Sinus" medications contain acetaminophen and if used together an overdosage may occur which can cause damage to the liver. Acetaminophen can also cause kidney damage if used for a prolonged period. And of course you should not mix these medications with other pain medications such as regular "Tylenol".

#4. Moisturizer: One of the body’s defenses in a cold is to wash out the sinuses with fluids. This is why you develop a runny nose. A moisturizer will often help in this process. It is important not to reduce the nose’s secretions because it helps to prevent sinus infections. Antihistamines which are contained in many cold medications dry secretions and thus may not be the drug of choice.

Over-The-Counter Medications for Colds

Decongestant and No Other Medications:

Sudafed Nasal Decongestant

Decongestant and Pain Medication:

Advil Cold & Sinus (has Ibuprofen--similar to aspirin)
Sinutab Sinus (acetaminophen)
Sudafed Cold & Sinus (acetaminophen)
Tylenol Sinus Non-Drowsy (acetaminophen)

Decongestant and Moisturizer:

Robitussin PE* (100 mg Guaifenesin per teaspoon)
Sudafed Non-Drying Sinus* (200 mg Guaifenesin)

Decongestant, Cough Suppressant and Pain Medication (Acetaminophen)

Sudafed Cold & Cough
Sudafed Severe Cold Formula
Tylenol Cold
Vicks Dayquil Cold/Flu Relief*
Theraflu - Non-Drowsy Formula Flu, Cold and Cough

Moisturizer and Cough Suppressant:

Robitussin DM*

Moisturizer:

Robitussin* (100 mg Guaifenesin per teaspoon)

Decongestant Nose Sprays:

Afrin
Dristan
Neosynephrine
Triaminic Infant
Vicks Sinex

Decongestant and Cough Suppressant

Robitussin Pediatric Cough & Cold*
Vicks 44D Cough & Head Congestion Relief*

Decongestant, Cough Suppressant, Pain Medication (Acetaminophen) and Moisturizer.

Sudafed Cold & Cough

* Denotes Elixir or Liquid Medication

NOTE: Many "Cold" & "Sinus" medications contain acetaminophen. If used together, liver damage can occur from an over dosage.

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