General Guidelines:
A cold is generally non-life threatening (except to the sufferer). My general admonition is except for analgesics/anti-pyretics is to inform the requester that should they decide to treat the cold, it would last for seven days and if they did not, it would last a week. You need to ask plenty of questions such as any medical conditions. Diabetics should be instructed to watch their blood sugars more carefully as infections tend to increase glucose levels. Patients with kidney disease should not take NSAIDS. Patients with BPH should be careful with anti-muscarinic agents.
Children under two should be treated with a vaporizer (cool mist), nasal aspirator,acetaminophen and elevate the head of the crib/bed.
I try to avoid combination products. Most of the time the symptoms do not always last the same amount of time. If you have a patient with fever, headache and nasal congestion and you recommend Advil Cold and Sinus, you are likely going to give them more NSAID then they need as the nasal congestion is likely to last longer than the fever or headache. This is especially true of Analgesic/DXM combinations as cough seems to outlast other symptoms by a wide majority.
Analgesics/Antipyretics: This is a matter of personal preference. I prefer acetaminophen as it is less toxic than NSAIDS. Remind them of the total daily limit of 4 GM/day. Also remind to avoid EtOH. Avoid aspirin in patient's under 18. Watch NSAIDS in patients on diuretics, H2 blockers, PPI's, Warfarin and Low-dose Aspirin.
Antihistamines:When recommending sedating antihistamines with pronounced antimuscarinic activity such as diphenhydramine and chlorpheniramine warn of sedation. In some sates you can get a DUI for antihistamine use. Also warn about dry mouth, (chew sugarless gum) and dry eyes (especially for contact lens wearers), constipation and urinary retention (especially in the elderly). Also be aware that antihistamines are problematic in patients who have any type heart rhythm irregularity. I try to recommend Claritin with the proviso it is not as effective for treating cold symptoms as the older antihistamines.
Nasal Decongestants:
I think PSE is way more effective than PE. Be careful in patients that have hypertension and heart rhythm irregularity. Also warn of insomnia. PSE can effect urinary flow in men over 50. Also be careful with products that once had PSE with a dose of two tablets and now have PE with a dose of one tablet.
Cough Suppressants/Expectorants:This is the area of greatest controversy. There are many people who believe there is no proof of efficacy for these compounds. I think the information here is sketchy. I try to rely on personal (therefore anecdotal and suspect) experience. I think the only way DXM and guaifenisin work is in high doses so I am stuck recommending Delsym and Mucinex. I do have anecdotal proof of efficacy, but not much more. There are some recent studies that show honey is just as effective as DXM, but I'm not convinced
Generally your job is to use your clinical skills to ask the right questions so you can get the correct medications to your patients. Remembering a cold is not life threatening and you don't want to provide treatment that will do more harm than the original condition. Sometimes less is more. It's also important to know what to look for so you can refer the patient to their physician. Lethargy, blood in the sputum and fever lasting more than a few days are some of the triggers to let you know it's time to refer. It's a little easier in children. If the snot is clear and they are eating, drinking and playing you are pretty safe, if not, they definitely get the contact your physician warning.
