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Non-antibiotic treatments for upper-respiratory tract infections (common cold).

Abstract

OBJECTIVES

To review the seven Cochrane reviews of non-antibiotic treatment for the common cold.

METHODS

Each Cochrane review was read and summarized, and results presented as relative risks and, where possible, numbers needed to treat.

RESULTS

The main theme that runs through these Cochrane reviews is the variable quality of the primary studies. In general, the reviewers are fairly cautious about the benefits of any of the treatments other than first-dose decongestants and antihistamine-decongestant combinations. For antihistamines alone, the reviewers were clear about the lack of efficacy except in the high-quality studies in which a global improvement in symptoms was noted. Some studies were statistically significant, but the Cochrane reviewers were guarded about how clinically significant they were. For Echinacea, problems were found with the quality of the studies and the wide range of different forms of this substance. Heated humidified air seemed to be effective in the UK and Israel, but not the USA, making definitive statements about efficacy difficult. Over-the-counter medication for cough seemed to have no documented benefit in children under the age of 5 years. Letosteine (a mucolytic) may be effective in children but is not available in the UK. Bisolvon (a mucolytic) was found to be effective for cough in only one study. For older children and adults, dextromethorphan may be effective (two out of three studies showed benefit), and guiafenesin (an expectorant) showed mixed benefit in two trials. Dexbrompheniramine (a sedating antihistamine)/pseudoephedrine (6 mg/120 mg twice daily for 1 week) was significantly more effective than placebo for severity of cough, whereas, in another study, loratadine (a non-sedating antihistamine)/pseudoephedrine (5 mg/120 mg twice daily for 4 days) did not show any difference between the study groups. Vitamin C may have a small role in preventing the common cold, with possibly a greater role in high-intensity physical activity and sub-arctic conditions. Zinc lozenges seemed to be effective, but the issue of unblinding due to taste was a methodological issue of concern to the reviewers. The benefits and harms are calculated as numbers needed to treat for one person to benefit (NNTB) and numbers needed to treat for one person to harm (NNTH), and were calculated by the author.

CONCLUSION

Most non-antibiotic treatments for the common cold are probably not effective. The most promising are dextromethorphan, bisolvon and guiaphenesin for cough, antihistamine-decongestant combinations for a wide range of symptoms, nasal decongestants (at least for the first dose) and possibly zinc lozenges.

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  • Authors+Show Affiliations

    Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand. b.arroll@auckland.ac.nz

    Source

    Respiratory medicine 99:12 2005 Dec pg 1477-84

    MeSH

    Adult
    Ascorbic Acid
    Child
    Common Cold
    Echinacea
    Evidence-Based Medicine
    Histamine H1 Antagonists
    Hot Temperature
    Humans
    Humidity
    Nasal Decongestants
    Nonprescription Drugs
    Phytotherapy
    Placebos
    Randomized Controlled Trials as Topic
    Respiratory Tract Infections
    Zinc

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    16291073

    Citation

    Arroll, B. "Non-antibiotic Treatments for Upper-respiratory Tract Infections (common Cold)." Respiratory Medicine, vol. 99, no. 12, 2005, pp. 1477-84.
    Arroll B. Non-antibiotic treatments for upper-respiratory tract infections (common cold). Respir Med. 2005;99(12):1477-84.
    Arroll, B. (2005). Non-antibiotic treatments for upper-respiratory tract infections (common cold). Respiratory Medicine, 99(12), pp. 1477-84.
    Arroll B. Non-antibiotic Treatments for Upper-respiratory Tract Infections (common Cold). Respir Med. 2005;99(12):1477-84. PubMed PMID: 16291073.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Non-antibiotic treatments for upper-respiratory tract infections (common cold). A1 - Arroll,B, PY - 2005/05/15/received PY - 2005/09/07/accepted PY - 2005/11/18/pubmed PY - 2006/4/18/medline PY - 2005/11/18/entrez SP - 1477 EP - 84 JF - Respiratory medicine JO - Respir Med VL - 99 IS - 12 N2 - OBJECTIVES: To review the seven Cochrane reviews of non-antibiotic treatment for the common cold. METHODS: Each Cochrane review was read and summarized, and results presented as relative risks and, where possible, numbers needed to treat. RESULTS: The main theme that runs through these Cochrane reviews is the variable quality of the primary studies. In general, the reviewers are fairly cautious about the benefits of any of the treatments other than first-dose decongestants and antihistamine-decongestant combinations. For antihistamines alone, the reviewers were clear about the lack of efficacy except in the high-quality studies in which a global improvement in symptoms was noted. Some studies were statistically significant, but the Cochrane reviewers were guarded about how clinically significant they were. For Echinacea, problems were found with the quality of the studies and the wide range of different forms of this substance. Heated humidified air seemed to be effective in the UK and Israel, but not the USA, making definitive statements about efficacy difficult. Over-the-counter medication for cough seemed to have no documented benefit in children under the age of 5 years. Letosteine (a mucolytic) may be effective in children but is not available in the UK. Bisolvon (a mucolytic) was found to be effective for cough in only one study. For older children and adults, dextromethorphan may be effective (two out of three studies showed benefit), and guiafenesin (an expectorant) showed mixed benefit in two trials. Dexbrompheniramine (a sedating antihistamine)/pseudoephedrine (6 mg/120 mg twice daily for 1 week) was significantly more effective than placebo for severity of cough, whereas, in another study, loratadine (a non-sedating antihistamine)/pseudoephedrine (5 mg/120 mg twice daily for 4 days) did not show any difference between the study groups. Vitamin C may have a small role in preventing the common cold, with possibly a greater role in high-intensity physical activity and sub-arctic conditions. Zinc lozenges seemed to be effective, but the issue of unblinding due to taste was a methodological issue of concern to the reviewers. The benefits and harms are calculated as numbers needed to treat for one person to benefit (NNTB) and numbers needed to treat for one person to harm (NNTH), and were calculated by the author. CONCLUSION: Most non-antibiotic treatments for the common cold are probably not effective. The most promising are dextromethorphan, bisolvon and guiaphenesin for cough, antihistamine-decongestant combinations for a wide range of symptoms, nasal decongestants (at least for the first dose) and possibly zinc lozenges. SN - 0954-6111 UR - https://www.unboundmedicine.com/medline/citation/16291073/Non_antibiotic_treatments_for_upper_respiratory_tract_infections__common_cold__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(05)00424-5 DB - PRIME DP - Unbound Medicine ER -