eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Rhinovirus Infection: Treatment & Medication

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: May 13, 2009

Treatment

Medical Care

  • The following treatment options are still experimental and not proven in rhinovirus (RV) infection:
    • Developing a vaccine: Development of a vaccine is nearly impossible because of the numerous serotypes. No antiviral agents are available to treat infections.
    • Accelerating nasal drainage: Hot chicken soup causes a temperature increase that accelerates nasal drainage. Be aware of possible hypernatremia.
    • Providing inhaled, warm, humidified air: Nasal hyperthermia is based on the fact that increased temperatures inhibit rhinovirus replication in vitro. Inhaled, warm, humidified air (40 L/min at 40-44°C in nostrils) has produced inconsistent findings in several studies.
    • Using aroma rubs, homeopathic and/or herbal remedies, and ultrafine high-volume filtration systems: These treatment options have yet to be studied.
    • Using experimental drugs: Many experimental drugs are currently in trials or have not been approved for consumer use. These include capsid-binding agents, pirodavir, WIN 54954, intranasal interferon (IF), virus receptor blockers, antireceptor antibodies, and soluble ICAM-1.
  • Most treatment provides supportive measures for respiratory illness symptoms. Conventional treatments for the common cold include the following:
    • Using phenol-alcohol–based compounds (Lysol) to disinfect the environment
    • Washing hands
    • Obtaining rest, plenty of fluids, and reassurance that the usual viral course is 6-10 days
    • Positioning mattress at a 45° angle
    • Providing comfortable surrounding temperature and adequate humidity (this treatment method soothes irritated nasopharyngeal mucosae and helps eliminate nasal secretions by preventing dryness)
    • Using decongestants (decongestants and antihistamines are not recommended for children younger than 6 y and have not been shown to be efficacious at any age)
    • Using nasal saline drops with bulb syringe nostril aspiration (this treatment can help infants with congestion and obstruction)
    • Discontinuing smoking or using alcohol

Consultations

  • Refer to an allergist if patient has chronic rhinitis that is unresponsive to environmental and pharmacologic intervention.

Medication

Symptomatic treatment with analgesics, decongestants, antihistamines, and antitussives is currently the mainstay of therapy. Some clinicians advocate supplementation with vitamin C; however, high doses in children are not recommended. Zinc lozenges are not practical because of the metallic taste. Other drugs that are currently experimental or not approved for rhinovirus include the following:

  • Interferon alpha: Most effective for cold prevention, interferon alpha is ineffective for established colds. When administered through nasal spray, 80% of secondary rhinovirus (RV) colds were prevented. Interferon alpha is not cost-effective. Significant adverse effects have been reported.
  • Pirodavir: A substituted phenoxy-pyridazinamine, pirodavir, possesses broad antipicornavirus activity. Clinical studies demonstrate no decrease in viral shedding or symptoms.
  • WIN 54954: A methylisoxazole derivative, WIN 54954, has no significant antiviral or clinical effects.
  • Virus receptor blockers: These drugs are hypothesized to block virus internalization to prevent replication.
  • Antireceptor antibody: Tests demonstrate no decrease in infection frequency.
  • Soluble ICAM-1: This drug consists of a molecule that blocks replication by binding receptor sites and inhibiting viral attachment and internalization. Currently, no clinical trials have been performed.

Remind parents that treatment of children younger than 6 years should be supervised by a physician. Doses for analgesics, cough suppressants, decongestants, and antihistamines should only be given on the advice of a physician for children younger than 6 years.

Cough and cold medication use

The US Food and Drug Administration (FDA) does not recommend the use of cough and cold medications in very young children (ie, age <2 y). In January 2008, the FDA completed its review of information regarding the safety of over-the-counter (OTC) cough and cold medicines in children younger than 2 years. This review resulted in a new recommendation that these drugs should not be used to treat children in this age group because serious and potentially life-threatening adverse effects can occur.

In October 2008, the pharmaceutical industry voluntarily changed the labeling for OTC pediatric cough and cold drugs to include that they should not be used in children younger than 4 years. This action was in response to dosing errors, misuse, and overuse of OTC pediatric cough and cold medications. Each year, nearly 7000 visits to EDs in the United States by children younger than 11 years are associated with cough and cold medicines.

Health care providers should emphasize to parents and caregivers that, although OTC medications are available without a prescription, that does not mean that they are harmless. Discuss the merits of hydration, rest, and humidification as initial treatment options. Most importantly, parents should seek specific instructions from their child’s physician if cough or cold medications are warranted and should only give the precise amount of medication that is prescribed. Carefully instruct parents and caregivers not to add other cough and cold medications to the regimen in order to avoid overdose. Adverse effects, including deaths, have occurred due to unintentional overdose when different OTC or prescription medications that contain the same ingredients (eg, pseudoephedrine, dextromethorphan, antihistamines, analgesic/antipyretic) have been combined.

An article published in the Morbidity and Mortality Weekly Report (MMWR) estimated that about 1500 children younger than 2 years were treated in US EDs during 2004-2005 for adverse events, including overdoses, associated with cough and cold medications.8

For more information see CDC MMWR: Infant Deaths Associated with Cough and Cold Medications, FDA MedWatch, Medscape Medical News, Potential Dangers of Cough and Cold Medications in Children, or Medscape Pediatrics Perspective.

Analgesic and antipyretic agents

These agents are used for relief of pain, discomfort, or fever. They inhibit central synthesis and release of prostaglandins that mediate effect of endogenous pyrogens in hypothalamus; thus, they promote return of set-point temperature to within the reference range. Ibuprofen also possesses anti-inflammatory properties.


Ibuprofen (Motrin, Advil)

One of few NSAIDs indicated for reduction of fever.

Adult

200-400 mg PO q4-6h while symptoms persist, not to exceed 3.2 g/d

Pediatric

5-10 mg/kg/dose PO q6-8h, not to exceed 40 mg/kg/d or 2.4 g/d

Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when concurrently administered

Documented hypersensitivity; aspirin; active GI bleeding and ulcer disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy; caution in infants and young children; do not use in neonates secondary to CNS effects


Acetaminophen (Tylenol, Feverall, Tempra)

Reduces fever by directly acting on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Adult

325-650 mg PO q4-6h or 1000 mg tid/qid, not to exceed 4 g/d

Pediatric

10-15 mg/kg/dose PO/PR q4-6h, not to exceed 2.6 g/d

Rifampin can reduce acetaminophen analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Documented hypersensitivity; known G-6-PD deficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Contained in many OTC products, and combined use with these products may result in cumulative doses exceeding recommended maximum dose; caution parents regarding varying concentrations of OTC products

Antihistamines

These agents relieve runny nose, watery eyes, or other allergylike symptoms. They act by competitive inhibition of histamine at H1 receptor. This mediates wheal and flare reactions, bronchial constriction, mucous secretions, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.


Brompheniramine (BroveX, J-Tan)

Alkylamine antihistamine primarily used for treating allergic symptoms. Available in various dosage forms, including long-acting preparations, chewable, suspension, and prescription infant drops.

Adult

Regular release: 4 mg PO q4-6h
SR: 8 mg PO q8-12h; 12 mg PO q12h

Pediatric

<4 years: Use only with physician recommendation
4-6 years: 0.5 mg/kg/d PO divided q6-8h, not to exceed 6-8 mg/d
6-12 years: 2-4 mg/dose PO q6-8h, not to exceed 12-16 mg/d
>12 years: Administer as in adults

Potentiates effect of CNS depressants; MAOIs, sympathomimetics; propranolol

Documented hypersensitivity; narrow-angle glaucoma; bladder-neck obstruction; concurrent use of MAOIs

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

High blood pressure; heart disease; diabetes; thyroid disease; asthma; glaucoma

Decongestants

These agents relieve congestion of nasal passages or sinuses.


Pseudoephedrine (Sudafed)

Stimulates vasoconstriction by directly activating alpha-adrenergic receptors of respiratory mucosa. Also induces bronchial relaxation and increases heart rate and contractility by stimulating beta-adrenergic receptors.

Adult

60 mg q4-6h or 120 mg SR q12h, not to exceed 240 mg/d

Pediatric

<4 years: Use only with physician recommendation
4-6 years: 3.75-7.5 mg (1.25-2.5 mL of 15 mg/5 mL solution) PO q6h prn
6-12 years: 7.5-15 mg PO q6h
>12 years: 30-60 mg/dose PO q6-8h, not to exceed 240 mg/d

Propranolol, MAOIs, and sympathomimetic agents may increase toxicity; methyldopa and reserpine may reduce effects

Documented hypersensitivity; severe anemia; postural hypertension or hypotension; closed-angle glaucoma; head trauma; cerebral hemorrhage

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hyperthyroidism; diabetes mellitus; prostatic hypertrophy; mild-to-moderate hypertension; arrhythmia; hyperglycemia


Phenylephrine nasal (Neo-Synephrine)

Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity; produces vasoconstriction of arterioles, which decreases congestion.

Adult

2-3 gtt or 1-2 sprays intranasally of 0.5% solution q4h

Pediatric

<4 years: Use only with physician recommendation
4-6 years: 2-3 gtt intranasally of 0.125% solution q4h prn
6-12 years: 2-3 gtt intranasally or 1-2 sprays of 0.25% solution q4h prn
>12 years: 2-3 gtt intranasally or 1-2 sprays of 0.5% solution q4h

Bretylium may potentiate action of vasopressors on adrenergic receptors, possibly resulting in arrhythmias; MAOIs may significantly enhance adrenergic effects, and pressor response may be increased 2- to 3-fold; guanethidine may increase pressor response of direct-acting vasopressors, possibly resulting in severe hypertension

Documented hypersensitivity; pheochromocytoma and severe hypertension; acute pancreatitis; hepatitis; myocardial disease; severe coronary disease; peripheral or mesenteric vascular thrombosis

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Arrhythmia; hyperthyroidism; hyperglycemia

Antitussive agents

These agents centrally or peripherally act (or combination of both) on cough reflex. Central-acting agents increase threshold of cough center in brain to incoming stimuli, whereas those acting peripherally decrease sensitivity of receptors in respiratory tract.


Dextromethorphan (Robitussin, Delsym)

Antitussive and/or expectorant that comes as single entity or in various cough and cold preparations in various combinations.

Adult

Regular release: 10-30 mg PO q4-8h, not to exceed 120 mg/d
SR: 60 mg PO bid

Pediatric

<4 years: Use only with physician recommendation
4-6 years: 2.5-7.5 mg PO q4-8h, not to exceed 30 mg/d
6-12 years: 5-10 mg PO q4-6h, not to exceed 60 mg/d
>12 years: Administer as in adults

May decrease hypotensive effects of guanethidine; MAOIs significantly may enhance adrenergic effects

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

High blood pressure or tachycardia; thyroid disorders; diabetes mellitus


Codeine

For symptomatic relief of cough. Helpful for pain of intercostal muscle strain associated with cough. Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception and response to pain.

Adult

10-20 mg/dose PO q4-6h prn for cough, not to exceed 120 mg/d

Pediatric

<2 years: Contraindicated
1-1.5 mg/kg/d PO divided q4-6h prn

CNS depressants; TCAs may potentiate codeine effects; phenothiazine may antagonize analgesic effect; dextromethorphan may enhance analgesic effect

Documented hypersensitivity; children <2 y

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Hypersensitivity reactions to other phenanthrene-derivative opioid agonists; respiratory diseases; severe liver and/or renal insufficiency

Vitamin C

These agents may decrease severity and duration (large doses not recommended for children).


Ascorbic acid (Vita-C)

Effect on cold severity and duration is still controversial. Vitamin C comes in various formulations.

Adult

Dietary supplement: 50-200 mg/d PO
Prevention and treatment of cold: 1-3 g/d PO

Pediatric

Dietary supplement: 35-100 mg/d PO

Decreases effects of warfarin and fluphenazine; increases aspirin levels

Documented hypersensitivity; pregnancy, if large doses administered

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Prolonged high doses may cause renal calculi, especially in patients with diabetes

More on Rhinovirus Infection

Overview: Rhinovirus Infection
Differential Diagnoses & Workup: Rhinovirus Infection
Treatment & Medication: Rhinovirus Infection
Follow-up: Rhinovirus Infection
Multimedia: Rhinovirus Infection
References
Further Reading
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Keywords

rhinovirus infection, common cold, adenovirus, Bordetella pertussis, Chlamydia psittaci, Coccidioides immitis, coronaviruses, Coxiella burnetii, coxsackieviruses groups A and B, croup, echoviruses, enterovirus, hepatitis A virus, hepatovirus, Histoplasma capsulatum, intercellular adhesion molecule-1, ICAM-1, lower respiratory infection, LRI, Mycoplasma pneumoniae, nasal congestion, nasal discharge, nasopharyngitis, numbered enteroviruses, parainfluenza, parechoviruses, pneumonia, polioviruses, respiratory syncytial virus, RSV, rhinorrhea, RV infection, sneezing, throat irritation, upper respiratory infection, URI, viremia, parainfluenza, acute otitis media, AOM, treatment, diagnosis

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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