COLD AND FLU MANAGEMENT

Most upper respiratory infections are viral, and antibiotics will not help (or may be harmful causing rash, diarrhea or creating resistant “super bugs”).  We instead focus on reducing symptoms until your immune system can catch up.

Signs that you have developed a secondary bacterial infection and need may need an antibiotic:
  • Sinus symptoms lasting more than 10-14 days
  • You get “Second Sickening” - you start to get better and then get a lot worse suddenly 
  • Cough combined with fever or shortness of breath

Strep throat almost always comes with high fever, NO cough, pus pockets on the tonsils, and swollen lymph nodes in the neck. It is also much more common in children than adults. Presence of cough makes it much more likely that it is viral.
Most treatments are available over-the-counter. Items marked with * DO require a prescription

Treatment for ages 12 and Over                   

Congestion/Sinus Drainage
  • Oral decongestants: These will help reduce congestion.  They can raise your blood pressure, so double check with your doctor if you have high BP. Only choose 1 of these medications, do not take both medications at the same time! Phenylephrine 10mg every 4-6 hours or Sudafed 30-60 mg every 6-8 hrs (ID required for purchase of Sudafed).  
  • Antihistamines: These will help with sinus drainage and will work better for those who have seasonal allergies. *Zyrtec, Claritin, or Allegra (non-sedating) and Benadryl (sedating). Benadryl is safe and helps with sleep. Please choose only 1 antihistamine medication to take, do not take multiple ones at the same time unless you speak with your doctor.
    • You can take these products (decongestant and antihistamine) separately, or purchase combination products like Claritin-D, Zyrtec-D, and Allegra-D. It is recommended to take BOTH a decongestant and antihistamine because they work better in reducing symptoms together, compared to only taking one or the other.
  • Afrin Nasal Spray: is a decongestant as well and helps with stuffy noses and difficulty breathing. Two sprays into each nostril 1-2 times daily for 3 days. It causes problems if used for more than 3 days in a row.
  • Nasal Sinus Rinse: These clear out the sinuses and get rid of snot. Make your own with 1 cup distilled or boiled water, ½ tsp salt, ½ tsp baking soda. You can also buy saline rinses OTC as packets or pre-mixed. 
  • Cool mist-humidifiers can provide moisture in the air to help loosen nasal secretions
  • Maintain adequate hydration to help thin secretions

Sore Throat
  • Phenol (Chloraseptic Spray) numbs the back of the throat.
  • Honey reduces both cough and sore throat in evidence-based studies. Helpful in warm drinks like tea.
  • Salt Water gargles. Mix one teaspoon of table salt in warm water and gargle for 30 sec, 3x per day.
  • Ingesting warm fluids (chicken soup) can loosen secretions and soothe the respiratory tract. 

Cough
  • *Atrovent Nasal Spray (1 spray into each nostril 2 to 4 times daily as needed) is a medication that improves persistent coughs. 
  • Ointment containing camphor, menthol, and eucalyptus oils: Vicks VapoRub (ages 2 and older) is an ointment that can be applied to the chest and neck regions to reduce coughing and relieve nasal congestion.
  • Cough Suppressant: Dextromethorphan (20 mg every 6 hrs; medicine in Robitussin or Delsym) is the most effective cough syrup – as beneficial as codeine-containing cough syrups with less side effects. Helps with significant reductions in cough frequency and severity during the first 2 days of treatment
  • *Tessalon Perles (100 mg every 6 hrs) works by suppressing the drive to cough in your brain.
  • Expectorant: Mucinex (200 mg every 4-6 hrs). Idea is to loosen up mucous. Does not work in studies, though the idea is good. If it helps you with symptom, go for it! There are minimal side effects.
  • Zinc acetate or Zinc gluconate lozenges are OTC products that can relieve cough and nasal discharge. It is recommended to take at least 25 to 75 mg of zinc per day and treatment is more effective when started within 3 days of symptom onset. 

Pain/Aches/Chills
  • NSAIDS: Ibuprofen (600-800 mg every 8 hrs) or Naproxen (Aleve) twice a day. You can take as long as you are not on another NSAID and do not have kidney disease.
  • Acetaminophen: Tylenol (1000 mg every 6-8 hrs). You can take as long as you are not taking combination medications containing Tylenol and do not have liver disease. ​​

Treatment for ages UNDER age 12                

Congestion/Sinus Drainage
  • Decongestants: Oral decongestants are not recommended in children under 12 years of age as the risks generally outweigh the potential benefit.  Talk with your doctor.
  • Antihistamines: These help with sinus drainage and work better for those who have seasonal allergies. Zyrtec, Claritin, or Allegra (non-sedating) and Benadryl (sedating). Benadryl is safe and helps with sleep. Please choose only 1 antihistamine medication to take, do not take multiple ones at the same time unless you speak with your doctor.
  • Afrin Nasal Spray (two sprays into each nostril 1-2 times daily for 3 days) is a decongestant as well and helps with stuffy noses and difficulty breathing. It causes problems if used for more than 3 days in a row.
  • Nasal Sinus Rinse: Make your own with 1 cup distilled or boiled water, ½ tsp salt, ½ tsp baking soda. You can also buy saline rinses OTC as packets or pre-mixed. These clear out the sinuses and get rid of snot.
  • Nose Suction: Can use a bulb suction or a “nosefrida” to suction out snot from child’s nose.
  • Cool mist-humidifiers: Can provide moisture in the air to help loosen nasal secretions
  • Maintain adequate hydration to help thin secretions

Sore Throat
  • Phenol (Chloraseptic Spray) numbs the back of the throat.
  • Honey reduces both cough and sore throat in evidence-based studies. Helpful in warm drinks like tea. However, honey is not recommended in children younger than 12 months of age. 
  • Salt Water gargles. Mix one teaspoon of table salt in warm water and gargle for 30 seconds, 3 times per day.
  • Ingesting warm fluids (chicken soup) can loosen secretions and soothe the respiratory tract. 

Cough
  • Atrovent Nasal Spray (1 spray into each nostril 2 to 4 times daily as needed) is a medication that improves persistent coughs. For ages 5 and up.
  • Ointment containing camphor, menthol, and eucalyptus oils: Vicks VapoRub (ages 2 and older) is an ointment that can be applied to the chest and neck regions to reduce coughing and relieve nasal congestion.
  • Cough Suppressant: Dextromethorphan (15 mg every 6 hours; medicine in Robitussin or Delsym) is the most effective cough syrup – as beneficial as codeine-containing cough syrups with less side effects. Helps with significant reductions in cough frequency and severity during the first 2 days of treatment. For ages above 4 years.
  • Expectorant: Mucinex (50 mg every 4-6 hours). Idea is to loosen up mucus. Does not work in studies, though the idea is good. If it helps you with symptom, go for it! There are minimal side effects. For ages over 4 years.
  • Zinc acetate or Zinc gluconate lozenges are OTC products that can relieve cough and nasal discharge. Suggested dose is 10 to 15 mg of zinc per day and treatment is more effective when started within 3 days of symptom onset. 

Pain/Aches/Chills
  • Acetaminophen: see dosing charts below.
  • Ibuprofen: ages 6 months and over. See dosing charts below.