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Date posted: June 1, 2012

Noufira,Sakkir Hussain,Rubeesh Hassan  (3rd Year MBBS Students.Govt.Medical College.Calicut)

CONTENTS
1. BACKGROUND
2. REVIEW FROM PREVIOUS STUDY
3. RESEARCH QUESTION
4. OBJECTIVES OF STUDY
5. MATERIAL & METHOD
6. IMPLEMENTATION OF STUDY
7. ANALYSIS
8. CONCLUSION
9. COMMON COLD

I. Background
Common cold is an upper respiratory tract infection caused by viruses. which cannot be helped by antibiotics. Most do not require treatment and antibiotics are not necessary in uncomplicated cases. But in the present scenarios we see that antibiotics are used indiscriminately for common cold. Most of the doctors justify the use by giving the following reasons (1) Most of the common cold patients come to doctor 3-4 days after the onset of symptoms. In such a case if not treated with antibiotic may lead to severe complication and once they are developed it is difficult to control. (3) it is said proper rest will resolve the common cold in a week. but at present no one has time to rest. So every one like to get rid of the disease as soon as possible.

But these indiscriminate use of antibiotic results in increase in avoidable adverse effects, development of antibiotic resistance & unnecessary increase of cost of therapy

ii. Review from previous studies
A) A study conducted in USA by Dr. Arroll B. Kenealy T shows following results
There is no enough evidence of important benefits from the treatment of common with antibiotic. (Cochranereview. org)
B) Another study result
Antibiotic for common cold not only increases the cost of treatment unnecessarily, increase drug side effects & contribute to the evolution of antibiotic resistant bacteria..(Rosenstein, N, The common cold – principle of judicious use of antimocrobeal agent)

iii. Research question
Will a comparative study among 25 common cold patients treated with supportive medication and 25 patients treated with antibiotics in addition to supportive medication reveal more complication in former group.

IV. Objectives of study
1. To detect the complication of common cold in 25 patients treated with supportive medication by the help of questionnaire and personal contact
2. To detect the complication of common cold in 25 patients treated in addition with antibiotics by questionnaire and personal contact.
3. Compare the complications in both groups from the collected information and to asses the effect of antibiotic therapy for common cold
4. To compare the treatment expense in both groups

V. Material & method
Design of study: Descriptive study
Subjects: 50 diagnosed cases of common cold 25 of them treated with supportive medication and 25 treated in addition with prophylactic antibiotic therapy.
Inclusion criteria: patient presented with running nose, Sneezing. Throat pain, Cough are diagnosed as common cold
Exclusion criteria: Patient without watering. Sneezing, Nasal block, are excluded. Patient with allergic rhinitis

VI. Implementation of study
Prepare 50 questionnaire containing details to be gathered from the patients with the help of Dr. Bindu (Dep. of Community Medicine).
With the help of this questionnaire details of clinical presentation & treatment taken are to be collected from 25 patients using antibiotic and 25 patients taking symptomatic treatment.
These patients are followed up for 10 days. Assess the out come of their illness by noting development of complication after the end of follow up period.
Compare the complication developed in both group by analyzing the information obtained and comment whether prophylactic antibiotic therapy required in all cases of common cold.

VII. Analysis
50 patients are selected. Age groups are given below-

Age group (yrs) Cases
1-10        2
11-20     11
21-30     27
31-40      4
41-50      4
50-60      2
Table-Vll” a

From this Table it is clear that only few cases are in extreme age group( In extreme age groups prophylactic antibiotics are usually indicated since they
are more prone to develop complication

Frequency of clinical presentation
Watering from nose
Group 1    76%
Group II   92%
Gp – I – patients using antibiotic
Gp – II – patients using only supportive Rx

Sneezing
Group 1       80%
Group 11     76%

Throat pain
Group 1      84%
Group 11   52%

Cough
Group 1     80 %
Group 11   48%

Nasal block
Group 1     60%
Group 11   76%

Fever
Group 1     68%
Group 11   56%

Head ache
Group 1    68%
Group 11  36%

Above tables shows the clinical presentation of the patients. Most of the patients among group I presented with watering from nose, Sneezing , Throat
pain. Cough. Group II patients most present with watering sneezing and nasal block. This shows that both groups of patients came with more or less similar symptoms.

Duration of time between first symptom and consultation: -
1-3 days       4-7 days
Group 1     72%             28%
Group 11   72%             28 %

Most of the patients (72 %) consult the doctor with in 1 -3 days

Treatment details:
Usa
ge of house holds remedies:
Group1       42%
Group 11    32%

Self-medication:
Group 1      30%
Group 11    16%

Follow up Details
75 % cure rate after 10 days.
75 % cure               Complicated
Group 1        60%                          40%
Group 11      60%                          40%
Value      Df          Assymp – sig
Pearson chi   .000        1             1.000
square

Complication among group I to group II:
Purulent sputum                                                      value       df        Assy-sig
Group I    36%                         Pearson chi square -  .000        1          1.000
Group II   24%

Fever                                                                         Value    Df     Assymp sis
Group 1     36%                             Pearson chi square  1.587    1       .208
Group 11   20%

Chest pain                                                                    Value  Df    Assym-siq
Group1    24%                                   Pearson chi square .000   1        1.000
Group11  8%

Sneezing                                                           Value     Df     Assym-siq
Group I    16%                        Pearson chi square   2.000   1        .157
Group II    4%

Cough                                                   Value  Df     Assym-siq
Group 1    44%         Pearson chi square .000    1          1.000
Group 11  44%

Above table (VII – m to VII – r) shows that there is no significant difference is complication developed in group one and group two. Even though comparison of tables shows some difference in percentage of complication developed, chi square test of each complication developed gives Assym-siq of >.05- To say there is significant difference, this value should be less than 0.05]

Side effect of the usage of Antibiotics:-
Side effect               % of patients getting this complication
Gastric irritation            20%
Diarrhea                       12%
Metallic taste                 4%
Loss of appetite              4%

Working day loss due to common cold
Group 1      48%
Group 11    16%

Tables VII -s shows some complication that came due to the use of antibiotic
Table VII -1 shows the working day loss in both groups of patients

Cost of therapy
Average expense of treatment for patient receiving antibiotic therapy was found to be Rs – 85 /- and patient taking symptomatic treatment was Rs:
16/-

Vl11. Conclusion
50 People aged between 3 – 58 yrs were included in this study. Their course of illness (common cold) studied. Results show that there is no added complication among the patient taking symptomatic treatment compared to patients taking antibiotic. It is found that patients taking antibiotic spend more money for treatment, than other group, even though there is no added benefit. .’ ‘

Since the sample size taken for study was small (50 patients) further study including large groups are recommended to confirm the result.

COMMON COLD

Colds are minor infections of the nose and throat caused by several different viruses.

A cold may last for about one week, but some colds last longer, especially in children, elderly people, and those in poor health. Adults get an average of two to four colds per year, mostly between September and Many young children suffer from an averages of six to eight colds per year.

Colds are highly contagious. They most often spread when droplets of fluid that contain a cold virus are transferred by touch. These droplets may also be inhaled.

Cold Symptoms
Between one and three days after a cold virus enters the body, symptoms stat developing, such as:
Runny nose
Congestion
Sneezing
Weakened senses of taste and smell
Scratchy throat
Cough

Infants and young children are more likely than adults and teens to develop a fever. Smokers usually have more severe symptoms than non- smokers.

WHAT CAN BE DONE IF YOU CATCH A COLD?
Symptom Relief

Over – the – counter medications Can provide temporary relief of symptoms and should be used as soon as you feel a cold coming on.
Acetaminophen (paracetamol) is the preferred over – the counter medication for relief of the aches and pains associated with a cold. It is less likely to upset your stomach than other non- steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen 9e.g., Motrin IB ®). Studies have shown thataspirin or any other NSAID may worsen asthma and /or peptic ulcers. Acetaminophen (e.g., Tyienol dD) seems less likely to worsen asthma. Aspirin should not be used in children under eighteen years old because it may play a role in causing Reye Syndrome, a rare but severe liver and central nervous system condition. Be sure to discuss all medication choices with your doctor.

Congestion , cough and nasal discharge are best treated with a combination of decongestant and antihistamine. There are many over- the counter cold remedies that contain both of these ingredients, such as..paracetamol <8) Cold Severe Congestion.

REMEMBER
to follow dosage instructions oh all product labels and know what is in the medication you are taking. Many combination products- both prescription and over- the counter – contain acetaminophen (e.g.. paracetamol ) , ibuprofen (brufen), or aspirin. It is important to read the ingredients on each product label to avoid accidentally taking too much of these

There are no antiviral medications available for treating the common cold. Antibiotics are not useful for treating a cold, and should only be taken to treat bacterial complications that arise from it.

Other remedies
Herbs and minerals such as Echinacea. eucalyptus, garlic, honey, lemon, menthol, zinc, and vitamin c have been getting a lot of publicity as cold remedies. However, none of these claims are solidly supported by scientific studies.

Adequate liquid intake i
s a must. Eight glasses of water and / or juice per day are recommended. This will help keep the lining of the nose and throat
from drying out. so that mucus remains moist and easy to clear from the nose.

Avoid coffee, tea or cola drinks that contain caffeine. Also avoid any drinks that contain alcohol. Caffeine and alcohol lead to dehydration, the opposite of what you want.
Bed rest is a good idea for a speedy recovery.
If you smoke, stop! Stay away from other smokers; inhaling their smoke will further irritate your throat and make you cough even more.

What can you do to prevent a cold?
Colds are extremely difficult to prevent entirely. The following suggestions may help:

Avoid close contact with people who have a cold. especially during the first few days when they are most likely to spread the infection.Wash your hands after touching someone who has a cold, after touching an object they have touched, and after blowing your own nose. If your child has a cold, wash his or her toys after play.

Keep your fingers away from your nose and your eyes to avoid infecting yourself with cold virus particles that you may have picked up.Put up a second hand towel in the bathroom for healthy people to use. Keep an eye on the humidity of your environment so that your sinuses do not dry out. Do not inflict
your cold on others 1 Cover your nose and mouth with a tissue when you cough or sneeze, than throw the tissue away land wash your hands. Also. stay away from people who are most vulnerable, including anyone who has asthma or another chronic ling disease, or at least try to limit close contact.

Until recently, it was thought that a single vaccine could not be developed for the different cold viruses. New research approaches may enable the development of a single vaccine for most types of colds.

Complications of a cold
Colds get better within a few days to weeks, whether or not you take medication. However, a cold virus can pave the way for other infections to invade the body. including sinus or ear infections, and bronchitis. A common complication is a sinus infection with a prolonged cough. Inhaled steroids may be useful. If you have asthma, chronic bronchitis, or emphysema, your symptoms of those condition may be worsened for many weeks even after your cold has gone away

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