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What causes a cold?

Most short duration nasal symptoms are related to the large number of varieties of the rhinovirus. Influenza, parainfluenza, and RSV also cause respiratory symptoms, and are often more severe in their presentation. Symptoms usually begin with nasal irritation, sneezing, congestion, yellow drainage, and sore throat. A patient often feels bad during the first two to three days, and may have fever. The symptoms usually progress to a worsening of the sore throat, and a cough. Nasal congestion is most severe at two to three days, and then gets better. The cough may go on for up to two weeks, and may last for many weeks if the infection was caused by the influenza virus.

Doctor, just write me the magic prescription to make this problem go away!

The search for a treatment that will block the progression of the virus has been elusive, and there is no cure available at this time. Symptoms are self limited (that means that it is going to get better with or without treatment), and treatment is supportive. For the more severe viral presentations, an anti viral antibiotic may be indicated. Using Tylenol or Advil can help you feel better during the miserable time of the cold. Afrin nasal spray or an equivalent is very useful to relieve the severe congestion, and help you sleep. Use it sparingly for up to three days, then throw your bottle away. Make sure that you drink plenty of fluids, and get as much sleep as you can.

Can I take herbal supplements and expect some relief?

It is during the early phase that the herbal supplements have been purported to make some improvement. Zinc can block the spread of viral transmission from cell to cell, and can be useful. I do not recommend use of Zinc inside the nose, as it can destroy your sense of smell. Use it at your own risk. Vitamin C lozenges can relieve some symptoms. Other ingredients are unproven at this time. Specifically, Echinacea has been shown to be of no benefit in several studies. If you take the remedies right when the first symptoms appear, some patients will have viral infections that don’t last as long.

Doctor, give me an antibiotic, and I’ll feel better

Actually, you won’t get any better, but you will have resistant bacteria the next time that you actually need an antibiotic. Save them for when you need them. The use of a Z pak has resulted in a near complete lack of effectiveness of this medication. It does have an anti-inflammatory effect, which might make you feel better. Take Advil for the same effect without the risk. Antibiotics are for bacterial infections.

It is when patients begin to worsen between day five and seven of a severe cold that there is concern that Acute Bacterial Rhinosinusitis may be present. It is at this time that you should seek medical attention, and an antibiotic may be appropriate.