DEC. 21, 2000 | The latest update of Medical News from eDocAmerica includes the following summary of research on treatments for colds and coughs.

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eDocAmerica / DEC., 2000 | Irwin and Madison, in the New England Journal of Medicine, address one of the most common dilemmas patients and doctors have this time of year. When to prescribe antibiotics for patients with sinus infections, nasal drainage and acute cough.

They note in their article on treatment of cough that the common cold is actually the most common cause of cough. 83 of patients with colds have cough at the end of 48 hours and 26 per cent still have one at the end of 14 days. They note that dexbromphenerimine and pseudoephedrine are the most effective treatments for the common cold with cough and note that one of the most common treatments, nonsedating antihistamines such as claritin and allegra are not likely to be effective in the common cold because, unlike allergy, the cold isn't mediated by histamine.

They also note that the common cold is actually a form of viral sinus infection and that it is intially impossible to tell the difference between a viral and a bacterial sinus infection. Since viral infections of the sinus are so much more common than bacterial, they recommend not using antibiotics to treat them unless they fail to show progressive improvement with treatment with decongestants, and unless two of the following are present: purulent (green or yellow) nasal secretions, pain in the face over the upper teeth, or an abnormal office exam using transillumination of the sinuses.

They also note that, since doctors and patients often don't realize that the cold so often causes cough and phlegm, patients with colds are often treated with antibiotics as if they had bacterial bronchitis. The authors also recommend against this practice; it isn't effective, may lead to side effects from the medication, and encourages emergence of resistant bacterial strains.

Some cases of acute bronchitis do need treatment with antibiotics. These include patients with pertussis, those with chronic lung disease (such as emphysema, and frail, elderly patients who may have pneumonia. CWS

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