Treatment of URIs in Children - upper respiratory tract infections

Author: Anne D. Walling
Date: Nov 15, 2000

(Hong Kong--Hong Kong Practitioner, May 2000, p. 242.) Upper respiratory tract infections (URIs) are a group of common conditions with symptoms such as cough, sore throat, fever, rhinorrhea, nasal congestion and malaise. URIs account for up to two thirds of pediatric primary care consultations. Although drugs are often prescribed for the treatment of URIs, there is little objective evidence of benefit; some medications may even cause significant risk of adverse effects. Antibiotics have not been shown to improve symptoms or shorten periods of illness when compared with placebo. The use of antibiotics to treat URIs may lead to antibiotic resistance in pathogenic organisms. The most widely used antitussives--codeine, dextromethorphan and diphenhydramine--provided relief comparable to that of placebo. Syrup alone may act as a demulcent and provide antitussive action without side effects. Expectorant and mucolytics have not shown significant benefit in clinical trials and may cause gastric irritation. While antihistamines are often prescribed, they are unlikely to benefit patients with URIs because histamine is not the main mediator of symptoms. In URI with rhinorrhea, antihistamines can dry the nasal mucosa. Similarly, decongestants may be expected to relieve symptoms but have performed poorly in clinical trials. Vitamin C has been used to treat and prevent URIs. However, no consistent prophylactic effect was seen in studies; the duration of symptoms was reduced by about one-half day. Finally, zinc did not reduce the severity or duration of symptoms, but was associated with diarrhea, nausea and oral symptoms, including offensive taste. The optimal treatment of childhood URI appears to be rest, hydration and antipyretics with monitoring for the development of more serious illness.

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