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[Common cold: diagnostic steps? Antibiotics?]
1Division des maladies infectieuses, Hôpital cantonal universitaire, Genève.
Abstract:
The common cold is caused by more than 100 virus types. However, the clinical manifestation is always similar with rhinorrhea, stuffiness, sneezing, pharyngitis, laryngitis and cough. The local inflammatory reactions are not due to the presence of virus but caused by locally produced inflammatory mediators. Bacterial superinfections may cause otitis or sinusitis. Bacterial nasopharyngitis has been described in children. This entity possibly exists also in adults. Traditional viral cultures are rarely positive and are not recommended in the daily routine. In children, antigen detection for adenovirus, respiratory syncytial virus, parainfluenza and influenza virus are recommended to confirm the viral etiology or for epidemiological surveillance. The presence of group-A streptococci must be proven by culture or antigen detection before treatment with penicillin. Antiviral treatment is limited to interferon or ribavirin. New antiviral substances are in development. Today, treatment of common cold is limited to symptomatic measures, and antibiotic treatment is not justified.
Insights
The common cold, caused by numerous viruses, presents with similar symptoms. Current treatments focus on symptom relief, as antibiotics are not justified for viral infections.
Area of Science:
- Virology
- Immunology
- Infectious Diseases
Context:
- The common cold involves over 100 viral types, leading to consistent symptoms like rhinorrhea and cough.
- Inflammatory mediators, not the viruses themselves, drive local reactions.
- Bacterial superinfections (otitis, sinusitis) can occur, with bacterial nasopharyngitis noted in children and potentially adults.
Purpose:
- To review the etiology, diagnosis, and treatment of the common cold.
- To differentiate viral and bacterial causes and guide appropriate management.
- To highlight limitations in current diagnostic and antiviral therapies.
Summary:
- Common cold symptoms stem from over 100 viruses, with inflammation mediated locally.
- Diagnostic methods include antigen detection for specific viruses in children; bacterial confirmation is crucial for antibiotic decisions.
- Antiviral options are limited, and symptomatic treatment is the current standard; antibiotics are not indicated for viral colds.
Impact:
- Emphasizes the need for symptomatic care and judicious antibiotic use in common cold management.
- Highlights the role of inflammatory mediators in cold symptoms.
- Informs clinical practice regarding diagnosis and treatment of viral upper respiratory infections.