Acute Rhinitis (Common Cold, Coryza)

Introduction

Acute Rhinitis is an acute inflammation of the nasal mucosa with variable degrees of pharyngitis.
Rhinoviruses are the commonest
aetiologically important agents followed by the coronaviruses, the parainfluenza, RSV, influenza and adenoviruses in that order.
Others include enteroviruses, rubella,
varcella and possibly a sizeable group of
undiscovered viruses.

Clinical Features

Systemic complaints are often absent or
modest if present.

  • Fever is usual.

Features may include

  • Tickling sensation in the nose associated with itching of the nose and palate
  • Occasional vertigo due to associated viral labyrinthitis.
  • Watery nasal discharge (rhinorrhoea), which may later become purulent
  • Sneezing
  • Headaches
  • Nasal obstruction (usually alternating)

Differential Diagnosis

  • Allergic rhinitis
  • Bacterial rhinitis (often supervenes after the viral onset)

Complication

  • Superimposed bacterial rhinitis
    • Suspect this if symptoms last longer than 7-10days
  • Sinusitis
  • Lower respiratory infection
  • Otitis media
  • Obstruction of internal auditory meatus: this may cause deafness.

Management

Treatment objectives

  • Relieve nasal mucosal oedema and
    obstruction
  • Relieve pain & discomfort
  • Treat complications

Drug treatment

1. Symptoms of rhinorrhea and sneezing

This can be relieved with non-selective
sedating antihistamines such as
chlorpheniramine,.
Selective H-receptor inhibitors are not
effective.
Chlorpheniramine

  • Adult 4mg orally every 4-6hrs up to a maximum of 24mg/day, maximum of 12mg/day in elderly.
  • Child
    • 1-2 years: 1mg b.d
    • 2-6 years: 1mg every 4-6hours (max 6mg/day)
    • 6-12 years: 2mg every 4-6hours (max 12mg/day)

2. Symptoms of headache,
myalgias and occasional fever

This can be relieved with analgesics
Paracetamol

  • Adults: 1 gm three times daily
  • Child:
    • 1-5 years: 120-250mg
    • 6-12 years: 250-500mg
    • 12-18 years: 500mg 6hourly (max 4 doses/day)

Non-steroidal anti-inflammatory drugs
(IBUPROFEN) may improve symptoms
in adults with rhinovirus infection.

3. Symptoms of nasal decongestion

Nasal sprays containing decongestants
should not be used for more than 5-7days to avoid rebound rhinitis medicamentosa on withdrawal
Ephedrine hydrochloride nasal drops

  • 1 – 2drops into each nostril up to 3-4 times daily for a maximum duration of 7days.
  • Applicable to adults and children over 12years.

Notable adverse drug reactions

  • Paracetamol: raised liver enzymes, renal papillary necrosis
  • NSAIDs : Upper G.I bleeding