Rhinoviruses Treatment & Management

  • Author: Michael Rajnik, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 15, 2011
 

Medical Care

Rhinoviral infections are predominately mild and self-limited; thus, treatment is generally focused on symptomatic relief and prevention of person-to-person spread and complications. The mainstays of therapy include rest, hydration, antihistamines, and nasal decongestants.

Antibacterial agents are not effective unless bacterial superinfection occurs. Development of effective antiviral medications has been hampered by the short course of these infections. Because peak symptom severity occurs at 24-36 hours after inoculation, antivirals have only a narrow window to positively affect a rhinoviral infection. In addition, the cause of the common cold is not always rhinoviral infection. Therefore, rapid and accurate diagnostic tests would be needed if a specific antiviral therapy were developed.

  • Because of the large number of rhinovirus immunotypes and the inaccessibility of the conserved region of the viral capsid (the most likely effective site for targeting a vaccine), no rhinovirus vaccine is on the horizon.
  • Because infection is spread by hand-to-hand contact, autoinoculation, and, possibly, aerosol particles, emphasize appropriate hand washing, avoidance of finger-to-eyes or finger-to-nose contact, and use of nasal tissue.
  • Heated humidified air has been used for decades for the alleviation of symptoms due to rhinoviral infections but has never been shown to improve objective outcome measures.[5]
  • Numerous agents are under investigation for the treatment of viral infections.
    • Pleconaril inhibits approximately 92% of rhinovirus serotypes. Susceptibility to pleconaril depends on the viral capsid surface protein VP1. A double-blind, randomized, placebo-controlled trial of pleconaril 400 mg PO tid for 5 days, initiated within 24 hours of symptom onset, resulted in a decrease in the duration of symptoms by 1 day.[6]
    • Steroids have been examined as a therapeutic modality and have shown little effect with rhinoviruses. One recent article noted that children who experienced wheezing during a rhinoviral infection and were treated with prednisolone experienced fewer wheezing episodes than untreated individuals in the subsequent 2 months. However, no change in time to discharge was noted.[7]
    • A blinded, placebo-controlled trial using intranasal interferon-alpha-2b and ipratropium with oral naproxen started within 24 hours of rhinovirus inoculation decreased viral shedding, geometric mean virus titers, and symptoms in the treatment group. Similar findings were reported with the use of intranasal interferon-alpha-2b, chlorpheniramine, and ibuprofen. Recombinant interferon-alpha-2b applied topically to the nose at 5 million U or more per day prevented experimental infections. Unfortunately, the effect of this agent on symptomatic illness was limited.[8]
    • A recombinant soluble intercellular adhesion molecule-1 (ICAM-1) administered intranasally 6 times per day and beginning either 7 hours before or 12 hours after rhinovirus challenge was analyzed in a randomized, double-blinded study. Neither strategy affected the incidence of infection, but combining results from both treatment groups found a 23% decrease in clinical colds, a 45% decrease in total symptom score, and a 56% decrease in total nasal secretion weight.[9]
    • 3C protease inhibitors are currently being evaluated in human trials, but no data are currently available. A phase II study found that ruprintrivir, a 3C protease inhibitor, delivered as a nasal spray was well tolerated and decreased positive viral culture results and improved symptom scores but did not decrease the frequency of colds.[10] These drugs act by interfering with the cleaving of a single large polyprotein that produces individual structures and enzymatic proteins of the virus.
    • Rhinoviruses are sensitive to low pH. In one recent study, citrate/phosphate buffers were administered intranasally, decreasing viral shedding but failing to decrease symptomatology.[11]
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Diet

Dietary supplements have been touted as possible therapeutic or preventive measures.

  • Although large doses of vitamin C have been used for prevention and treatment of colds, controlled trials reveal minimal therapeutic benefit and no preventive qualities.[12]
  • Zinc has been found to inhibit rhinovirus replication in vitro, but no proven benefit has been shown in vivo on virus activity or immune modulation. A Cochrane Database Systemic Review of 13 therapeutic trials and two preventative trials determined that zinc administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in otherwise healthy individuals.[13] When administered for at least 5 months, zinc reduces cold incidence. However, zinc lozenges may have side effects, and recommended dosing, formulations, and duration are difficult to establish without further studies.
  • The genus Echinacea consists of 3 species of plants used medicinally for their reported nonspecific stimulation of the immune system.
    • Echinacea purpurea has recently been studied and did not show any differences in rates of infection or severity of illness when compared with placebo. Although reports of improved symptoms have been described, validation and standardization of products is necessary.[14]
    • Echinacea angustifolia has also been examined in the prophylaxis and treatment of experimental rhinoviral infection. Neither the rate of infection nor the severity of symptoms were found to be statistically significantly affected when E angustifolia was used either prophylactically or at the time of challenge.[15]
    • In contrast, a recent meta-analysis of echinacea indicated that, in properly designed studies, patients receiving placebo were 55% more likely to experience cold symptoms than patients taking echinacea. The most striking part of this meta-analysis was that 231 of 234 articles identified were excluded because they did not control for the type of viruses causing the colds. Echinacea extracts will continue to be evaluated.[16]
    • A randomized, controlled trial of echinacea pills assessed the potential benefits as a treatment for the common cold.[17] The study included 719 patients, 713 of which completed the protocol. Illness duration and severity were not statistically significant for patients taking echinacea compared with those taking placebo.
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Activity

Patients may limit their activity during the course of the infection, with clinical improvement occurring 48-72 hours after the prodrome of symptoms.

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Contributor Information and Disclosures
Author

Michael Rajnik, MD  Associate Professor, Department of Pediatrics, Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences

Michael Rajnik, MD is a member of the following medical societies: American Academy of Pediatrics, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory William Rutecki, MD  Associate Professor, Program Director, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University

Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Gordon L Woods, MD  Consulting Staff, Department of Internal Medicine, University Medical Center

Gordon L Woods, MD is a member of the following medical societies: Society of General Internal Medicine

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Calvo C, Garcia-Garcia ML, Blanco C, et al. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J. Oct 2007;26(10):904-8. [Medline].

  2. Pappas DE, Hendley JO, Hayden FG, et al. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J. Jan 2008;27(1):8-11. [Medline].

  3. Winther B, McCue K, Ashe K, et al. Environmental contamination with rhinovirus and transfer to fingers of healthy individuals by daily life activity. J Med Virol. Oct 2007;79(10):1606-10. [Medline].

  4. Jennings LC, Anderson TP, Werno AM, et al. Viral etiology of acute respiratory tract infections in children presenting to hospital: role of polymerase chain reaction and demonstration of multiple infections. Pediatr Infect Dis J. Nov 2004;23(11):1003-7. [Medline].

  5. Singh M. Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2004;CD001728. [Medline].

  6. Hayden FG, Herrington DT, Coats TL, et al. Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. Clin Infect Dis. Jun 15 2003;36(12):1523-32. [Medline].

  7. Jartti T, Lehtinen P, Vanto T, et al. Evaluation of the efficacy of prednisolone in early wheezing induced by rhinovirus or respiratory syncytial virus. Pediatr Infect Dis J. Jun 2006;25(6):482-8. [Medline].

  8. Gwaltney JM Jr, Winther B, Patrie JT, et al. Combined antiviral-antimediator treatment for the common cold. J Infect Dis. Jul 15 2002;186(2):147-54. [Medline].

  9. Turner RB, Wecker MT, Pohl G, et al. Efficacy of tremacamra, a soluble intercellular adhesion molecule 1, for experimental rhinovirus infection: a randomized clinical trial. JAMA. May 19 1999;281(19):1797-804. [Medline].

  10. Hayden FG, Turner RB, Gwaltney JM, et al. Phase II, randomized, double-blind, placebo-controlled studies of ruprintrivir nasal spray 2-percent suspension for prevention and treatment of experimentally induced rhinovirus colds in healthy volunteers. Antimicrob Agents Chemother. Dec 2003;47(12):3907-16. [Medline].

  11. Gern JE, Mosser AG, Swenson CA, et al. Inhibition of rhinovirus replication in vitro and in vivo by acid-buffered saline. J Infect Dis. Apr 15 2007;195(8):1137-43. [Medline].

  12. Schwartz AR, Togo Y, Hornick RB, et al. Evaluation of the efficacy of ascorbic acid in prophylaxis of induced rhinovirus 44 infection in man. J Infect Dis. Oct 1973;128(4):500-5. [Medline].

  13. Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev. Feb 16 2011;2:CD001364. [Medline].

  14. Sperber SJ, Shah LP, Gilbert RD, et al. Echinacea purpurea for prevention of experimental rhinovirus colds. Clin Infect Dis. May 15 2004;38(10):1367-71. [Medline].

  15. Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. Jul 28 2005;353(4):341-8. [Medline].

  16. Schoop R, Klein P, Suter A, et al. Echinacea in the prevention of induced rhinovirus colds: a meta-analysis. Clin Ther. Feb 2006;28(2):174-83. [Medline].

  17. Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, et al. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. Dec 21 2010;153(12):769-77. [Medline]. [Full Text].

  18. Turner RB, Biedermann KA, Morgan JM, et al. Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections. Antimicrob Agents Chemother. Jul 2004;48(7):2595-8. [Medline].

  19. Halperin SA, Eggleston PA, Beasley P, et al. Exacerbations of asthma in adults during experimental rhinovirus infection. Am Rev Respir Dis. Nov 1985;132(5):976-80. [Medline].

  20. Lemanske RF Jr, Jackson DJ, Gangnon RE, et al. Rhinovirus illnesses during infancy predict subsequent childhood wheezing. J Allergy Clin Immunol. Sep 2005;116(3):571-7.

  21. Miller EK, Lu X, Erdman DD, et al. Rhinovirus-associated hospitalizations in young children. J Infect Dis. Mar 15 2007;195(6):773-81. [Medline].

  22. Wilkinson TM, Hurst JR, Perera WR, et al. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest. Feb 2006;129(2):317-24.

  23. Arola M, Ruuskanen O, Ziegler T, et al. Clinical role of respiratory virus infection in acute otitis media. Pediatrics. Dec 1990;86(6):848-55. [Medline].

  24. Arruda E, Pitkaranta A, Witek TJ Jr, et al. Frequency and natural history of rhinovirus infections in adults during autumn. J Clin Microbiol. Nov 1997;35(11):2864-8. [Medline].

  25. Dagher H, Donninger H, Hutchinson P, et al. Rhinovirus detection: comparison of real-time and conventional PCR. J Virol Methods. May 2004;117(2):113-21. [Medline].

  26. de Arruda E, Hayden FG, McAuliffe JF, et al. Acute respiratory viral infections in ambulatory children of urban northeast Brazil. J Infect Dis. Aug 1991;164(2):252-8. [Medline].

  27. Dick EC, Jennings LC, Mink KA, et al. Aerosol transmission of rhinovirus colds. J Infect Dis. Sep 1987;156(3):442-8. [Medline].

  28. Douglas RG, Lindgren KM, Couch RB. Exposure to cold environment and rhinovirus common cold. Failure to demonstrate effect. N Eng J Med. 1968;279:742-7.

  29. Ghosh S, Champlin R, Couch R, et al. Rhinovirus infections in myelosuppressed adult blood and marrow transplant recipients. Clin Infect Dis. Sep 1999;29(3):528-32. [Medline].

  30. Goldmann DA. Transmission of viral respiratory infections in the home. Pediatr Infect Dis J. Oct 2000;19(10 Suppl):S97-102. [Medline].

  31. Gwaltney JM Jr, Hendley JO, Simon G, et al. Rhinovirus infections in an industrial population. I. The occurrence of illness. N Engl J Med. Dec 8 1966;275(23):1261-8. [Medline].

  32. Gwaltney JM Jr, Hendley JO, Simon G, et al. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA. Nov 6 1967;202(6):494-500. [Medline].

  33. Gwaltney JM Jr, Phillips CD, Miller RD, et al. Computed tomographic study of the common cold. N Engl J Med. Jan 6 1994;330(1):25-30. [Medline].

  34. Harris JM 2nd, Gwaltney JM Jr. Incubation periods of experimental rhinovirus infection and illness. Clin Infect Dis. Dec 1996;23(6):1287-90. [Medline].

  35. Hendley JO, Gwaltney JM Jr. Mechanisms of transmission of rhinovirus infections. Epidemiol Rev. 1988;10:243-58. [Medline].

  36. Jartti T, Lehtinen P, Vuorinen T, et al. Persistence of rhinovirus and enterovirus RNA after acute respiratory illness in children. J Med Virol. Apr 2004;72(4):695-9. [Medline].

  37. Kirkpatrick GL. The common cold. Prim Care. Dec 1996;23(4):657-75. [Medline].

  38. Ledford RM, Patel NR, Demenczuk TM, et al. VP1 sequencing of all human rhinovirus serotypes: insights into genus phylogeny and susceptibility to antiviral capsid-binding compounds. J Virol. Apr 2004;78(7):3663-74. [Medline].

  39. Makela MJ, Puhakka T, Ruuskanen O, et al. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol. Feb 1998;36(2):539-42. [Medline].

  40. Malcolm E, Arruda E, Hayden FG, et al. Clinical features of patients with acute respiratory illness and rhinovirus in their bronchoalveolar lavages. J Clin Virol. Apr 2001;21(1):9-16. [Medline].

  41. McBride TP, Doyle WJ, Hayden FG, et al. Alterations of the eustachian tube, middle ear, and nose in rhinovirus infection. Arch Otolaryngol Head Neck Surg. Sep 1989;115(9):1054-9. [Medline].

  42. Monto AS, Bryan ER, Ohmit S. Rhinovirus infections in Tecumseh, Michigan: frequency of illness and number of serotypes. J Infect Dis. Jul 1987;156(1):43-9. [Medline].

  43. Monto AS, Ullman BM. Acute respiratory illness in an American community. The Tecumseh study. JAMA. Jan 14 1974;227(2):164-9. [Medline].

  44. Naclerio RM, Proud D, Lichtenstein LM, et al. Kinins are generated during experimental rhinovirus colds. J Infect Dis. Jan 1988;157(1):133-42. [Medline].

  45. Nicholson KG, Kent J, Hammersley V, et al. Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden. BMJ. Oct 25 1997;315(7115):1060-4. [Medline].

  46. Rotbart HA, Hayden FG. Picornavirus infections: a primer for the practitioner. Arch Fam Med. Sep-Oct 2000;9(9):913-20. [Medline].

  47. Sanders SP, Proud D, Permutt S, et al. Role of nasal nitric oxide in the resolution of experimental rhinovirus infection. J Allergy Clin Immunol. Apr 2004;113(4):697-702. [Medline].

  48. Smith CB, Kanner RE, Golden CA, et al. Effect of viral infections on pulmonary function in patients with chronic obstructive pulmonary diseases. J Infect Dis. Mar 1980;141(3):271-80. [Medline].

  49. Turner RB. The treatment of rhinovirus infections: progress and potential. Antiviral Res. Jan 2001;49(1):1-14. [Medline].

  50. van Kraaij MG, van Elden LJ, van Loon AM, et al. Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis. Mar 1 2005;40(5):662-9. [Medline].

  51. Wark PA, Johnston SL, Bucchieri F, et al. Asthmatic bronchial epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med. Mar 21 2005;201(6):937-47. [Medline].

  52. Winther B, Brofeldt S, Christensen B, et al. Light and scanning electron microscopy of nasal biopsy material from patients with naturally acquired common colds. Acta Otolaryngol. Mar-Apr 1984;97(3-4):309-18. [Medline].

 
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