The common cold (ផ្សាយ)
I. Is Common cold = flu ?
➔ Colds, along with coughs, represent the largest case load for primary
healthcare workers and must be # Δ from influenza
➔ Children contract colds (5-6/y) more frequently than adults (2-4/y)
➔ Cause of common cold /viral infection :
- rhinoviruses (accounting for 30–50% of all cases),
- coronaviruses, parainfluenza virus, respiratory syncytial virus and
adenovirus
Causes of cold and their relative incidence in community pharmacy
➔ flu / influenza virus
Incidence Cause
Most likely Virus infection
Likely Rhinitis, rhinosinusitis, otitis media
Unlikely Influenza
The common cold (ផ្សាយ)
II. Symptoms
➔ Symptoms usually include:
● sore throat (+++) + runny nose (+++) +
coughing (++) + sneezing (+++)
● Headaches(+/-) + body aches(+)
● Fever , Weakness (+)
➔ Most people recover within about 7-10
days
The common cold (ផ្សាយ)
II. Arriving at a differential diagnosis
Specific questions to ask the patient: The common cold
Question Relevance
Onset of symptoms - Peak incidence of flu → winter months; the common cold → any time.
- Flu symptoms → more abrupt onset than the common cold ( 1 or 2 days.)
- Summer colds → common, but seasonal allergic rhinitis → hay fever
Nature of symptoms - Marked myalgia, chills and malaise → flu >> common cold. Loss of appetite →
flu.
Aggravating factors - Headache/pain that is worsened by sneezing, coughing and bending over →
sinus complications.
- If ear pain is present, especially in children, middle ear involvement is likely.
The common cold (ផ្សាយ)
II. Arriving at a differential diagnosis
Conditions to eliminate
Likely causes
The common cold Vs - Nasal discharge→ more mucopurulent in case of common cold
Rhinitis (allergy) - Sneezing persistent in allergy then common cold
- Cough and sore throat more common in common cold >> allergy rhinitis
The common cold Vs - Sinusitis could be complication from common cold
Acute rhinosinusitis - Sinusitis : least two of these symptoms : blockage or congestion ,discharge
or UACS ,facial pain or pressure , reduction or loss of smell
- Sinusitis :Streptococcus and Haemophilus
Unlikely causes
Common cold Vs - Peak incidence of flu → winter months; the common cold → any time.
Influenza - Flu symptoms → more abrupt onset than the common cold ( 1 or 2 days.)
- Influenza : shivering, chills, malaise, marked aching of limbs, insomnia, a
non-productive cough , loss of appetite
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
Symptomatic treatment
● Rhinorrhoea (េហៀរសំេបារ)→ Antihistamine (anticholinergic ++)
● Nasal congestion (តឹង ចមុះ) → decongestants(sympathomimetic)
● Sneezing (កណ្ត្ស់) Itching (រមស់) → Antihistamines
● Headache → analgesic
Etiologic treatment
● Inflammation of the nasal→ Mast cell stabilisers, Corticosteroid
● Infection → Viral infection ( rare case use ) or bacteria (ATB)
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Rhinorrhoea (េហៀរសំេបារ)→ Antihistamine (anticholinergic ++)
Drug Dose Pregnancy & breastfeeding
Chlorpheniramine Child 1–23 months: 1 mg twice daily - 1sd trimester cam used but 2nd
Child 2–5 years: 1 mg q4-6hr trimester prefer loratadine.
Child 6–11 years: 2 mg q4-6hr - Monitor the child if if the mother
Child ≥ 12 years and adult: 4 mg q4-6hr was treated
Promethazine Child 2–4 years: 5 mg twice daily before Most manufacturers of antihistamines
meals and at bedtime advise avoiding their use during
Child 5–9 years:5–10 mg twice daily before pregnancy
meals and at bedtime
Child 10–adult: 10–20 mg 2–3 times a day
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Nasal congestion (តឹង ចមុះ) → decongestants(sympathomimetic)
Drug Dose Pregnancy & breastfeeding
2-3 gtt/sprays per nostril q12hr Use with caution if benefits
Oxymetazoline
outweigh risks
Pseudoephedrine Immediate release: 60 mg PO q4-6hr PRN Avoid, during first trimester
Extended release: 120 mg PO q12hr or Excreted in breast milk
240 mg PO q24hr
Phenylpropanolamine 2 to 6 years : 6.25 mg PO q4hr Use with caution if benefits
6 to 12 years : 12.5 mg PO q4hr outweigh risks
> 12 years : 25 mg PO q 4hr
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Sneezing (កណ្ត្ស់) Itching (រមស់) → Antihistamines (Sedative )
Drug Dose Pregnancy & breastfeeding
Child 2–4 years: 2.5mg q 3-4/d Use with caution if benefits
Alimemazine
Child 5–11 years : 5 mg q 3-4/d outweigh risks
Child 12–adult: 10 mg q 3-4/d
Elderly: 10 mg q 1-2/d
Chlorpheniramine Child 1–23 months: 1 mg twice daily - 1sd trimester cam used but 2nd
Child 2–5 years: 1 mg q4-6hr trimester prefer loratadine.
Child 6–11 years: 2 mg q4-6hr - Monitor the child if if the mother
Child ≥ 12 years and adult: 4 mg q4-6hr was treated
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Sneezing (កណ្ត្ស់) Itching (រមស់) → Antihistamines (Sedative )
Drug Dose Pregnancy & breastfeeding
Promethazine Child 2–4 years: 5 mg twice daily before meals Most manufacturers of
and at bedtime antihistamines advise avoiding their
Child 5–9 years:5–10 mg twice daily before meals use during pregnancy
and at bedtime
Child 10–adult: 10–20 mg 2–3 times a day
Hydroxyzine Child 6 months–5 years: 5–15 mg daily in divided Avoid use
doses
Child 6–17 years (<40kg):Initially 15–25 mg daily in
divided doses
Adult: 25 mg 3–4 times a day
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Sneezing (កណ្ត្ស់) Itching (រមស់) → Antihistamines
(Non-sedative)
Drug Dose Pregnancy & breastfeeding
Cetirizine Child 2–5 years: 2.5 mg twice daily Most manufacturers of
Child 6–11 years: 5 mg twice daily antihistamines advise avoiding their
Child 12–17 years: 10 mg once daily use during pregnancy
Adult: 10 mg once daily
Desloratadine Child 1–5 years: 1.25 mg once daily Most manufacturers of
Child 6–11 years: 2.5 mg once daily antihistamines advise avoiding their
Child 12–17 years: 5 mg once daily use during pregnancy
Adult: 5 mg once daily
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Sneezing (កណ្ត្ស់) Itching (រមស់) → Antihistamines
(Non-sedative)
Drug Dose Pregnancy & breastfeeding
Levocetirizine Child 6–17 years: 5 mg once daily Most manufacturers of antihistamines
Adult: 5 mg once daily advise avoiding their use during pregnancy
Fexofenadine Child 6–11 years: 30 mg twice daily Most manufacturers of antihistamines
Child 12–17 years: 120 mg once daily advise avoiding their use during pregnancy
Adult: 120 mg once daily
Loratadine Child 2–11 years (to 31 kg): 5 mg once daily May be acceptable
Child 2–11 years (> 31 kg): 10 mg once daily
Child 12–17 years: 10 mg once daily
Adult: 10 mg once daily
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
1. Symptomatic treatment
● Headache → analgesic
Drug Dose Pregnancy & breastfeeding
Paracetamol Child under 1 month: 10 mg/kg 3 or 4/d May be acceptable
Child 1 month and over: 15 mg/kg 3 or 4 /d
Adult: 1 g 3 or 4 times daily (max 4g/d)
Ibuprofen Child over 3 months: 5 to 10 mg/kg 3 to 4/d -Avoid. Contraindication from the
Child 12 year and over and adult: 200 to beginning of the 6th month
400 mg 3 to 4 times/d -Breast-feeding: No contraindication
(short term treatment)
Diclofenac 100 mg PO once, then 50 mg PO q8hr PRN Avoid unless the potential benefit
outweighs the risk ( the third trimester)
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
2. Etiologic treatment
● Inflammation of the nasal→ Mast cell stabilisers, Corticosteroid
Drug Dose Pregnancy & breastfeeding
Sodium cromoglicate Child: 1 spray 2–4 times a day No data
Adult: 1 spray 2–4 times a day
Dexamethasone 0.75-9 mg/day PO divided q6-12hr Avoid
Nasal corticosteroids 100 µg twice/d ,to be administered into No data
Beclometasone each nostril
Triamcinolone Child 6–11 years: 55 µg one/d,to be No data
administered into each nostril
Child 12–adult: 110 µg one/d,to be
administered into each nostril
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
2. Etiologic treatment
● Infection → Bacteria (ATB)
Drug Dose Pregnancy & breastfeeding
Amoxicillin Mild to moderate infections Generally acceptable
500 mg PO q12hr or 250 mg PO q8hr for 10-14 /d
Severe infections
875 mg PO q12hr or 500 mg PO q8hr for 10-14 days
Cephalexin 250 mg PO q6hr or 500 mg PO q12hr; dosage range, Generally acceptable
1-4 g/day in divided doses
Roxithromycin Child: 6-40 kg: 5-8 mg/kg daily. Avoid
Adult: 150 mg bid or 300 mg once / d for 5-10 days
The common cold (ផ្សាយ)
III. The strategy therapeutic of common cold
2. Etiologic treatment
● Infection → Bacteria (ATB)
Drug Dose Pregnancy & breastfeeding
Azithromycin Child 6 months–17 years (body-weight 15–25 kg): 200 mg Avoid
once daily for 3 days
Child 6 months–17 years (body-weight 26–35 kg): 300 mg
once daily for 3 days
Child 6 months–17 years (body-weight 36–45 kg): 400 mg
once daily for 3 days
Child 6 months–17 years (body-weight 46 kg and
above): 500 mg once daily for 3 days
Adult: 500 mg once daily for 3 day
The common cold (ផ្សាយ)
Ex1 : អ្នកជំងឺម្ន្ក់ចូលមកឱសថសា្ថ្នេហើយ េរៀបរាប់ពីអោការះ គាត់ ដូចជា េហៀរសំេបារ កណ្ត្ស់ េ ្ខ្លួនខ្ល្ំង 380C
ឈឺតាម សាច់ដុំ អស់កំលាំង ងងុយេគង ។ េតើបញ្ហ្ សុខភាព គាត់បណ្ត្លមកពី អី ? េតើ អ្នកេធើ ែផនការព្យាបាល
ដូចេមម្តេច ?
Ex2 : អ្នកមីងេសៅ ចូលមកឱសថសា្ថ្ន រកថ្ន្ំ សំរាប់ េហៀរសំេបារកូនគាត់ អោយុ ១០ឆ្ន្ំ ២៥ គីឡូ ។ េដោយសារ
កូនគាត់ តូវ េទៅសាលា គាត់ចង់បានថ្ន្ំ កុំេអោយងងុយេគង ។ េ ពីេហៀរសំេបារ កូនគាត់ េ ្ខ្លួន ៣៨0C ក្អក ។េតើ
អ្នកេធើ ែផនការព្យាបាល ដូចេមម្តេច ?
Procold + CTZ + Eugica +Neo-ephac
➔ Antitussive drugs
Sinex :2
1. Neo-Codion:codeine + Sulfogaiacol + Grindelia 2. Tussipax: Codeine + Ethylmorphine 3. Théralène:Alimémazine
4. Phenergan : promethazine
NSAID + Vit C:3
3. NEO-ephac: Terpine + Benzoate of Na + Dextromethorphan Multi :1
Procold + CTZ + Eugica +Neo-ephac
➔ Analgesic & NSAID drugs
1. Sara sirop : para oral suspension: 250 mg/5ml ; 120 mg/5ml 2. Poro sirop : para suspension 250 mg/5ml
3. EfferalgenMed Pédiatrique sirop : paracetamol 30mg/ml 4. UPRO sirop :ibuprofen
5. Doliprane sachet: 150 mg , 200 mg , 300 mg , 500 mg 6. Cinacort : triamcinolone 7. Celestar : betamethasone + Dexchlor
➔ Cold ; Rhinorrhea ; expectorant drugs
1. Tussin sirop : para + dextromethorphan + Methylephedrine + Chlorpheniramine + Guaifenesin + caffeine
2. Tiffy sirop: Para + phenylephrine + chlorpheniramine
3. Sinex forte sirop : dextromethorphan + Hydrobromide + phenylephrine +cetirizine + para
4. Well cold -K sirop: para + chlorpheniramine + tipepidine + methylephedrine + caffeine + methylparaben + propylparaben
5. Ascoril sirop: Salbutamol + Bromhexine + Guaiphenesin + Menthol 6.Flemex sirop: Carbocysteine 7. Rhinoril sachet: Para + chlorpheniramine
8. Acemuc sachet : acetylcysteine 200mg 9. Sinex forte Cp: para 400mg + Phenylephrine + dextromethorphan + cetirizine 5 mg
10.Eugica : Eucalyptol + menthol + Ginger 11.Eugica fort : Eucalyptol + menthol + Ginger + Cajuput
12. Procold pain reliever : para + Ibu+ caffeine 13.Granie-L: Levocetirizine 14. Telfast : Fexofenadine 15. CTZ : Cetirizine
➔ ATB drugs
1. Clamoxyl sachet : amoxicillin 250 mg 2. Augmentin sachet : amoxicillin 250 mg + clavulanic acid 31.25 mg
3. Cephalexin sachet : cephalexin 125 mg /250 mg 4. Ecoflox : cipro :500 mg 5.Augmentin 650 /1g 6.Cefixime 200mg
7. Roxiwin : Roxithromycin 150 mg 8. Zithromax : azithromycine
