Evidence-based management of upper respiratory infection in a family practice teaching clinic

Management of upper respiratory infection (URI) was examined in a family practice clinic to determine evidence-based practices, specifically for medication choice. Scientific evidence supports the use of decongestants and perhaps decongestant/antihistamine combinations in adolescents and adults and antipyretics in all age groups. The use of cold preparations for children younger than age 5 is not evidence based.

Data on demographics, medications prescribed, and over-the-counter medications recommended were collected from patient charts for 293 URI visits over a 6-month period. The cost of evidence-based URI treatment was compared with the cost of nonevidence-based treatment.

Thirty-three percent of patients younger than age 5 were given a prescription; 96% of the prescription cost in this age group was nonevidence based. Twenty-six percent of all patients seen were given unnecessary and potentially harmful medication. These unnecessary medications accounted for almost 60% of the total prescription cost. Various combinations of antihistamines, decongestants, and antitussives were most commonly prescribed.

Few medications have been shown to effectively alleviate the symptoms of the generally self-limited, benign common cold. Medications are often overprescribed, escalating health care costs and, in some cases, exposing the patient to dangerous side effects. Family physicians and educators are encouraged to reexamine their treatment and teaching practices for the common cold.