Category: cold and flu

Symptoms of upper respiratory infection include cough, sneezing, nasal discharge, nasal congestion,
runny nose, fever, scratchy or sore throat, and nasal breathing.Source: iStock

Upper respiratory tract infection (URTI) definition and facts

• Upper respiratory infections (URIs) are one of the most common reasons for doctor visits.
• Upper respiratory infections are the most common illness resulting in missed work or school.
• Upper respiratory tract infections can happen at any time but are most common in the fall and winter.
• The vast majority of upper respiratory infections are caused by viruses and are self-limited.
• Symptoms of upper respiratory infection include
  • cough,
  • sneezing,
  • nasal discharge,
  • nasal congestion,
  • runny nose,
  • fever,
  • scratchy or sore throat, and
  • nasal breathing.
• Antibiotics are rarely needed to treat upper respiratory infections and generally should be avoided unless the doctor suspects a bacterial infection.
• Simple techniques, such as proper handwashing and covering the face while coughing or sneezing, may reduce the spread of respiratory tract infections.
• The general outlook for upper respiratory infections is favorable, although, sometimes complications can occur.

Upper Respiratory Tract Infection

The Common Cold

The common cold refers to a viral infection of the upper respiratory tract. Characteristic symptoms
of the common cold include

• cough,
• stuffy or
• runny nose,
• scratchy or
• sore throat,
• sneezing.

Read more symptoms of the common cold »

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx.Source: Getty Images

What is an upper respiratory infection?

The upper respiratory tract includes the sinuses, nasal passages, pharynx, and larynx. These structures direct the air we breathe from the outside to the trachea and eventually to the lungs for respiration to take place.

An upper respiratory tract infection, or upper respiratory infection, is an infectious process of any of the components of the upper airway.

Infection of the specific areas of the upper respiratory tract can be named specifically. Examples of these may include rhinitis (inflammation of the nasal cavity), sinus infection (sinusitis or rhinosinusitis) — inflammation of the sinuses located around the nose, common cold (nasopharyngitis) — inflammation of the nares, pharynx, hypopharynx, uvula, and tonsils, pharyngitis (inflammation of the pharynx, uvula, and tonsils), epiglottitis (inflammation of the upper portion of the larynx or the epiglottis), laryngitis (inflammation of the larynx), laryngotracheitis (inflammation of the larynx and the trachea), and tracheitis (inflammation of the trachea).

Upper respiratory infections are one of the most frequent causes for a doctor visit with varying symptoms ranging from a runny nose, sore throat, cough, to breathing difficulty, and lethargy. In the United States, upper respiratory infections are the most common illness leading to missing school or work.

Although upper respiratory infections can happen at any time, they are most common in the fall and winter months, from September until March. This may be explained because these are the usual school months when children and adolescents spend a lot of time in groups and inside closed doors. Furthermore, many viruses of upper respiratory infection thrive in the low humidity of the winter.

Most upper respiratory infection is contagious.Source: iStock

Is an upper respiratory infection contagious?

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A majority of upper respiratory infections are due to self-limited viral infections. Occasionally, bacterial infections may cause upper respiratory infections. Most often, upper respiratory infection is contagious and can spread from person to person by inhaling respiratory droplets from coughing or sneezing. The transmission of respiratory infections can also occur by touching the nose or mouth by hand or other objects exposed to the virus.

The URTI is generally caused by the direct invasion of the inner lining (mucosa or mucus membrane) of the upper airway by the culprit virus or bacteria.Source: Getty Images

What are the causes of upper respiratory infection?

The URTI is generally caused by the direct invasion of the inner lining (mucosa or mucus membrane) of the upper airway by the culprit virus or bacteria. In order for the pathogens (viruses and bacteria) to invade the mucus membrane of the upper airways, they have to fight through several physical and immunologic barriers.

The hair in the lining of the nose acts as a physical barrier and can potentially trap the invading organisms. Additionally, the wet mucus inside the nasal cavity can engulf the viruses and bacteria that enter the upper airways. There are also small hair-like structures (cilia) that line the trachea which constantly moves any foreign invaders up towards the pharynx to be eventually swallowed into the digestive tract and into the stomach.

In addition to these intense physical barriers in the upper respiratory tract, the immune system also does its part to fight the invasion of the pathogens or microbes entering the upper airway. Adenoids and tonsils located in the upper respiratory tract are a part of the immune system that helps fight infections. Through the actions of the specialized cells, antibodies, and chemicals within these lymph nodes, invading microbes are engulfed within them and are eventually destroyed.

Despite these defense processes, invading viruses and bacteria adopt various mechanisms to resist destruction. They can sometimes produce toxins to impair the body's defense system or change their shape or outer structural proteins to disguise from being recognized by the immune systems (change of antigenicity). Some bacteria may produce adhesion factors that allow them to stick to the mucus membrane and hinder their destruction.

It is also important to note that different pathogens have varying abilities to overcome the body's defense system and cause infections.

Furthermore, different organisms require a varying time of onset from when they enter the body to when symptoms occur (incubation time). Some of the common pathogens for upper respiratory infection and their respective incubation times are the following:

The table shows the incubation period of the common pathogens for an upper respiratory infection.

Virus and Bacteria Organisms Incubation time (Days) Rhinoviruses1 – 5Group A streptococci1 – 5Influenza and parainfluenza viruses1 – 4Respiratory syncytial virus (RSV)7Whooping cough (pertussis)7 – 21Diphtheria1 – 10Epstein-Barr virus (EBV)4 – 6 weeks

An illustration showing visual symptoms of upper respiratory infection.Source: Getty Images

What are the symptoms of upper respiratory infection?

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Generally, the symptoms of upper respiratory infection result from the toxins released by the pathogens as well as the inflammatory response mounted by the immune system to fight the infection.

Common symptoms of upper respiratory infection generally include:

• nasal congestion,
• runny nose (rhinorrhea),
• nasal discharge (may change from clear to white to green)
• nasal breathing,
• sneezing,
• sore or scratchy throat,
• painful swallowing (odynophagia),
• cough (from laryngeal swelling and post nasal drip),
• malaise, and
• low-grade fever (more common in children).

Other less common symptoms may include

• foul breath,
• reduced ability to smell (hyposmia),
• headache,
• shortness of breath,
• sinus pain,
• itchy and watery eye (conjunctivitis),
• nausea,
• vomiting
• diarrhea, and
• body aches.

The symptoms of upper respiratory infection usually last between 3-14 days; if symptoms last longer than 14 days, an alternative diagnosis can be considered such as:

• sinusitis,
• allergy,
• pneumonia, or
• bronchitis.

Bacterial pharyngitis (strep throat due to group A Streptococcus) may be considered if symptoms continue to worsen after the first week in the absence of runny nose, cough, or conjunctivitis. Prompt testing and initiation of appropriate antibiotics is important due to the risk of developing rheumatic fever, especially in children.

Epiglottitis is an upper respiratory infection in children that may have a more sudden onset of sore throat, feeling of a lump in the throat, muffled voice, dry cough, very painful swallowing, and drooling.

Respiratory infections in the lower part of the upper respiratory tract, such as, laryngotracheitis, are more commonly featured with dry cough and hoarseness or loss of voice. Barking or whooping cough, gagging, rib pain (from severe cough) are other symptoms and signs.

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Risk factors for an upper respiratory infection include contact with an infected individual such as shaking hands.Source: iStock

What are the risk factors for upper respiratory infection?

Some common risk factors for upper respiratory infection are:

• physical or close contact with someone with an upper respiratory infection;
• poor hand washing after contact with an individual with upper respiratory infection;
• close contact with children in a group setting, schools, or daycare centers;
• contact with groups of individuals in a closed setting, such as traveling, tours, cruises;
• smoking or second-hand smoking (may impair mucosal resistance and destroy the cilia);
• health care facilities, hospitals, nursing homes;
• immunocompromised state (compromised immune system) such as HIV, organ transplant, congenital immune defects, long term steroid use; and
• anatomical abnormalities as in facial trauma, upper airway trauma, nasal polyps.

QUESTION

Which illness is known as a viral upper respiratory tract infection?
See Answer

A mother and her son wait to see the doctor in the medical exam room.Source: Getty Images

When should you seek medical care for a respiratory tract infection?

Most people tend to diagnose and treat their symptoms at home without seeking professional medical care. A great majority of cases of upper respiratory infection are caused by viruses and are self-limited, meaning they resolve on their own spontaneously.

Visiting a doctor may be advisable if:

• symptoms last more than a couple of weeks,
• symptoms are severe and worsening,
• there is difficulty breathing,
• swallowing is impaired, and
• upper respiratory infection is recurring.

Sometimes hospitalization may be necessary if the upper respiratory infection is severe and causes significant dehydration, respiratory difficulty with poor oxygenation (hypoxia), significant confusion, lethargy, and worsening of shortness of breath in chronic lung and heart disease (chronic obstructive pulmonary disease or COPD, congestive heart failure). Hospitalizations are much more common in children less than 2 years of age, elderly people (especially those with dementia), and immunocompromised individuals (weak immune system).

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A doctor examines the throat of an infected patient looking for redness and enlargement of the tonsils.Source: iStock

How is an upper respiratory infection diagnosed?

In evaluating people with a suspected upper respiratory infection, other alternative diagnoses need to be considered. Some of the common and important diagnoses that can resemble upper respiratory infection are:

• asthma,
• pneumonia,
• H1N1 (swine) flu,
• influenza,
• allergic reactions,
• seasonal allergies,
• chronic (long-standing) sinusitis,
• acute HIV infection, and
• bronchitis.

The diagnosis of upper respiratory infection is typically made based on a review of symptoms, physical examination, and occasionally, laboratory tests.

In a physical examination of an individual with an upper respiratory infection, a doctor may look for swollen and redness inside the wall of the nasal cavity (a sign of inflammation), redness of the throat, enlargement of the tonsils, white secretions on the tonsils (exudates), enlarged lymph nodes around the head and neck, redness of the eyes, and facial tenderness (sinusitis). Other signs may include bad breath (halitosis), cough, voice hoarseness, and fever.

Laboratory testing is generally not recommended in the evaluation of upper respiratory infections. Because most upper respiratory infections are caused by viruses, specific testing is not required as there is typically no specific treatment for different types of viral upper respiratory infections.

Some important situations where specific testing may be important include:

• Suspected strep throat (fever, lymph nodes in the neck, whitish tonsils, absence of cough), necessitating rapid antigen testing (rapid strep test) to rule in or rule out the condition given possible severe sequelae if untreated.
• Possible bacterial infection by taking bacterial cultures with a nasal swab, throat swab, or sputum.
• Prolonged symptoms, as finding a specific virus can prevent unnecessary use of antibiotics (for example, rapid testing for the influenza virus from nasal or pharyngeal swabs).
• Evaluation of allergies and asthma which can cause long-lasting or unusual symptoms.
• Enlarged lymph node and sore throat as the primary symptoms that may be caused by the Ebstein-Barr virus (mononucleosis) with an expected longer time course (by using the monospot test).
• Testing for the H1N1 (swine) flu is suspected.

Blood work and imaging tests are rarely necessary for the valuation of upper respiratory infection. X-rays of the neck may be done if a suspected case of epiglottitis. Although the finding of swollen epiglottis may not be diagnostic, its absence can rule out the condition. CT scans can sometimes be useful if symptoms suggestive of sinusitis last longer than 4 weeks or are associated with visual changes, copious nasal discharge, or protrusion of the eye. CT scan can determine the extent of sinus inflammation, the formation of an abscess, or the spread of infection into adjacent structures (cavity of the eye or the brain).

A man takes cough medication (antitussives) to reduce the cough of his upper respiratory infection.Source: Getty Images

What is the treatment for upper respiratory infection?

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As described above, most cases of upper respiratory infection are caused by viruses and therefore, require no specific treatment and are self-limited. People with upper respiratory infections typically diagnose themselves and treat their symptoms at home without requiring a doctor's visit or prescription medications.

Rest is an important step in treating upper respiratory infections. Usual activities, such as working and light exercising may be continued as much as tolerated.

Increased intake of oral fluids is also generally advised to keep up with the fluid loss from a runny nose, fevers, and poor appetite associated with upper respiratory infections.

Treatment of the symptoms of upper respiratory infection is usually continued until the infection has resolved.

Some of the most common upper respiratory infection or cold medications used to treat these symptoms are the following:

• Acetaminophen (Tylenol) can be used to reduce fever and body aches.
• Nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) can be used for body aches and fever.
• Antihistamines such as diphenhydramine (Benadryl) are helpful in decreasing nasal secretions and congestions.
• Nasal ipratropium (topical) can be used to diminish nasal secretions.
• Cough medications (antitussives) can be used to reduce cough. Many cough medications are commercially available such as dextromethorphan, guaifenesin (Robitussin), and codeine all have shown benefits in reducing cough in upper respiratory infections.
• Honey can be used in reducing cough.
• Steroids such as dexamethasone (Decadron) and prednisone orally (and nasally) are sometimes used to reduce inflammation of the airway passage and decrease swelling and congestion.
• Decongestants such as pseudoephedrine (Sudafed) Actifed oral, phenylephrine (Neo-synephrine nasal) can be used to reduce nasal congestion (generally not recommended in children less than 2 years of age and not recommended for individuals with high blood pressure).
• Oxymetazoline (Afrin) nasal solution is a decongestant, but should only be used for short-term.
• Combination medications containing many of these components are also widely available over the counter.

Some cough and cold medicines that can cause excessive drowsiness need to be used with caution in children younger than 4 years of age and the elderly.

Broad-spectrum antibiotics are sometimes used to treat upper respiratory infections if a bacterial infection is suspected or diagnosed. These conditions may include strep throat, bacterial sinusitis, or epiglottitis. Antivirals may occasionally be recommended by doctors in patients who are immunocompromised (poor immune system). The treating doctor can determine which antibiotic would be the best option for a particular infection.

Because antibiotic use is associated with many side effects and can promote bacterial resistance and secondary infections, they need to be used very cautiously and only under the direction of a treating physician.

Inhaled epinephrine is sometimes used in children with severe spasms of the airways (bronchospasm) and in croup to reduce spam.

Rarely, surgical procedures may be necessary in cases of complicated sinus infections, compromised airway with difficulty breathing, the formation of abscesses behind the throat, or abscess formation of the tonsils (peritonsillar abscess).

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A simple home remedy to help with respiratory infections is to breathe steamed air from the humidifier.Source: Getty Images

What are home remedies for upper respiratory infection?

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Several self-care methods can simply be applied at home for relief of symptoms of upper respiratory infection.

Moist warm air can help soothe the oral and nasal passages that become more irritated with dry air. This can make breathing easier and nasal secretions looser and easier to discharge. Some simple ways to do this are:

• making steam in the shower by turning on the hot water (without going under it) and breathing the steamed air;
• drinking warm beverages (hot tea, hot chocolate, warm milk);
• using a vaporizer to create humidity in the room; and
• avoid cold, dry air if possible.

Nasal saline (saltwater) can help with symptoms of nasal congestion. There are over-the-counter saline spray solutions available that can be used for this purpose. Simpler and more cost-effective home-made saltwater solution may also be considered. A fourth of a teaspoon of salt can be added to an 8 oz cup of room temperature water and stirred to dissolve. Using a bulb syringe or a small spray bottle, the solution may be applied in one nostril at a time with slow inhalation and expelled with exhalation several times a day as needed.

Applying a warm pack (a warm well towel or washcloth) to the face may also be used to treat symptoms of nasal congestion. This can be repeated every few hours as needed to relieve the symptoms.

Saltwater gurgles and lozenges may reduce throat irritation and dryness and can alleviate the symptoms of throat symptoms.

Cough can be suppressed by limiting exposure to irritants, such as cold weather, cigarette smoke, dust, and pollution. Sleeping in a semi-upright position may be helpful at times to reduce cough. A study has suggested that honey may be superior to dextromethorphan in reducing cough in children with an upper respiratory infection.

Adequate hydration with water, juices, and non-caffeinated drinks can thin nasal secretions and replace the fluid losses.

Echinacea is a herbal remedy commonly used in treating upper respiratory infection.Source: Getty Images

What are some data on alternative therapies in treating upper respiratory infections?

Many alternative and cultural remedies are used in treating upper respiratory infections.

Herbal teas including elm bark and licorice root are thought to relieve sore throat and some studies have suggested benefits compared to placebo. Long-term use of these remedies has not been evaluated; however, prolonged use of licorice may cause elevation of blood pressure.

As noted above, honey has been shown to be beneficial in suppressing cough in children with an upper respiratory infection and its use in hot water or tea with lemon juice is not uncommon. Ingestion of honey in infants, however, is not recommended as they are not able to properly digest the spores in honey which can result in infections.

Echinacea is another herbal remedy commonly used in treating upper respiratory infection. Research data failed to prove any significant benefit in altering the duration and severity of upper respiratory infection symptoms when Echinacea was used in children between 2-11 years of age as compared to placebo.

Oral zinc supplementation has been used in recent years to shorten the duration and reduce the severity of symptoms of upper respiratory infection and the common cold. This therapy has been studied in children with an upper respiratory infection and the results are mixed. The FDA has not approved the use of oral zinc to treat the common cold or upper respiratory infections. There are reports of nausea and unpleasant taste caused by oral zinc.

Topical nasal zinc products (Zicam nasal gel) have been also used to attenuate the symptoms of upper respiratory infection. Some studies suggest the loss of the sense of smell (anosmia) associated with the use of this over-the-counter product. Therefore, the FDA recommended discontinuation of the use of intranasal zinc products in 2009.

The use of oral vitamin C is thought to shorten the duration of upper respiratory infection symptoms, but research data are inconclusive regarding the benefits of vitamin C.

Does a doctor examine a patient’s ear for infection?Source: Getty Images

What are the complications of an upper respiratory infection?

Some of the common complications of upper respiratory infections are the following:

• respiratory compromise from epiglottitis;
• secondary infection by bacteria (viral infection can cause impairment of the physical barrier in the respiratory airways making it easier for bacteria to invade) resulting in bacterial sinusitis, bronchitis, pneumonia;
• formation of abscesses in the tonsils;
• rheumatic fever from strep throat;
• spread of infection from sinuses to the brain (meningitis);
• involvement of the ears resulting in middle ear infections (otitis media);
• worsening of underlying chronic lung disease (asthma, COPD);
• spread of infection to the heart (pericarditis, myocarditis);
• spread of the infection to the brain or the fluid around the brain causing encephalitis or meningitis; and
• muscular pain and rib fractures from forceful coughing.

Hand washing is an encouraging preventive measure in reducing the spread of upper respiratory infections.Source: iStock

Can an upper respiratory infection be prevented?

There are several measures that can reduce the risk of infections in general. Smoking cessation, reducing stress, and adequate and balanced diet, and regular exercise are all measures that can improve the immune system and reduce the overall risk of infections. Breastfeeding also helps strengthen the immune system of infants by transferring the protective antibodies from the mother's milk to the baby.

Other preventive measures to diminish the risk of spread of upper respiratory infections are:

• a hand washing is especially encouraged during the cold seasons (fall and winter) or handling others with the infection;
• reducing contact with people who may have the infection (people may carry and spread the virus a few days before they have symptoms and a few days after their symptoms have resolved);
• proper cleaning of common objects that are touched by individuals who may be infectious such as, telephones, refrigerator door, computers, stair railings, door handles, etc.;
• covering mouth and nose when coughing or sneezing; and
• vaccination with flu vaccine as recommended for certain people (elderly, people with chronic medical conditions, health care workers, etc.).

A woman in her pajamas drinking tea.Source: Getty Images

What is the outlook for a patient suffering from an upper respiratory infection?

In general, the outcome of upper respiratory infection is good. The majority of these cases are due to viral infections that are self-limiting. Bacterial infections, people with weak immune systems, and those with complications of upper respiratory infections (listed above) may have a less favorable prognosis.

Sore throats typically last three to seven days; however, these remedies can soothe your pain and possibly help you get better faster.

Sore throats are a common problem for many of us. While most instances of sore throats tend to get better on their own, lasting about three to seven days, there are remedies you can try to soothe your throat and possibly get better faster, which includes:

• Suck on ice chips, popsicles or lozenges
  • Do not give lozenges to children younger than two years
  • Best to avoid if you suffer from asthma because cold exposure may worsen your symptoms
• Use a clean humidifier or cool-mist humidifier in your room
• Gargle with warm saltwater
• Drink warm beverages and plenty of fluids
• Use honey to relieve cough in adults and children older than one year of age
• Get plenty of rest
• Take over-the-counter medicine, such as acetaminophen or ibuprofen, to relieve pain and reduce fevers

Other remedies to get over your sore throat quickly can include:

• Throat lozenges
  • If you have a mild sore throat, sucking on a lozenge can help lubricate the throat because the sucking action helps produce saliva.
  • Also, ingredients, such as lemon and honey, in these products can help relieve irritation and stop the throat from feeling dry.
• Syrups
  • If your throat is dry and scratchy, using linctus syrup containing glycerin, honey and lemon can help soothe a sore throat by providing lubrication.
• Throat spray
  • For sore throats that are very painful and make it difficult to swallow, using throat sprays containing a local anesthetic could be a good option.
  • The effects work quickly since the spray is directed to the exact point at the back of the throat and works to numb the pain.
• Painkillers
  • For extremely inflamed sore throats, ibuprofen tablets will help.
  • Gargling with soluble aspirin (300-mg strength) is also an option because it targets the inflamed area at the back of the throat.
• Antibiotics
  • Since antibiotics won’t relieve your symptoms or speed up your recovery time, doctors don't typically prescribe them for sore throats. 
  • Doctors may only prescribe antibiotics if they think you have a bacterial infection.

What is a sore throat?

A sore throat is an irritation of the throat that is associated with pain or scratchiness and may make swallowing difficult. Often seen as the first warning sign of an infection, sore throats can be divided into these three categories, which depend on the area affected:

1. Pharyngitis: affects the area right behind the mouth.
2. Tonsillitis: swelling and redness of the tonsils, affecting the soft tissue in the back of the mouth.
3. Laryngitis: swelling and redness of the larynx.

Sometimes, white patches or areas of pus will form on the tonsils, which are more common in strep throat than in a sore throat caused by a virus.

What are the common causes of a sore throat?

Causes of sore throats can range from infections to injuries and may include:

Viral infection

• Viruses cause about 90 percent of sore throats, with the common cold and influenza as the top viral infections.

Bacterial infection

• Streptococcus bacterium is the most common cause of bacterial sore throat with strep throat causing nearly 40 percent of cases in children.
• Tonsillitis and sexually transmitted infections (gonorrhea and chlamydia) can also cause a sore throat.

Allergies

• When triggered by allergies (pollen, grass and pet dander), the immune system reacts by releasing chemicals that cause symptoms such as nasal congestion, watery eyes, sneezing and throat irritation.
• Excess mucus in the nose can drip down the back of the throat in a condition called postnasal drip, which can irritate the throat.

Injury

• Injuries such as aphthous ulcers or swallowing excessively hot liquids can cause pain in the throat. Additionally, getting a piece of food stuck in the throat can also irritate it.
• Repeated speech or shouting may strain the vocal cords and muscles in the throat causing a sore throat.

Tumor

• A tumor of the throat, voice box or tongue may cause a sore throat.
• When a sore throat is a sign of cancer, it does not go away after a few days.

Gastroesophageal reflux disease (GERD)

• A condition in which acid from the stomach backs up into the esophagus (the tube that carries food from the mouth to the stomach), which may result in a sore throat.

Dry air

• Dry air can suck moisture from the mouth and throat, which can leave them feeling dry and scratchy.
• Dry air is more common in the winter months when the heater is running.

Smoke, chemicals and other irritants 

• Many different chemicals and substances in the environment can irritate the throat, including cigarette and other tobacco smoke, air or traffic pollution, cleaning products and other chemicals.

The most common treatment for a sore throat is rest, which is essential to give your immune system the time it needs to fight your illness. Your doctor will prescribe antibiotics for bacterial infections, but viral infections need to run their course. If allergies cause a persistent sore throat, you will be referred to a specialist to discuss your triggers and explore medication and surgical options.

A stubborn cough can be annoying, but it typically isn’t a sign of something more serious and can be treated in the following ways.

Getting rid of a stubborn cough may require cough suppressants, steam inhalation, saline gargles and/or anti-inflammatory medications. Dextromethorphan, a cough suppressant (antitussive), is usually considered the first-line cough treatment. It may be given in combination with a mucolytic or expectorant (medications that loosen mucus in airways to be coughed out), such as guaifenesin.

A stubborn or chronic cough may require a doctor’s attention; however, people may try the following recommendations beforehand:

• Half a teaspoon of honey before sleep has been shown to soothe coughs related to upper airway infection.
• Sucking lozenges or sipping water may temporarily suppress a cough and relieve the sensations of throat irritation.
• For productive (wet) cough, mucolytic medications, such as N-acetyl cysteine (NAC), are important and designed specifically to break down the mucus, which is causing the irritation. Mucolytics have been shown to help reduce coughing in adults and children.
• In some cases, taking antitussives may help if antihistamines and expectorants are not helpful.
• Patients with recurrent episodes may need antibiotics, especially if a bacterial infection is diagnosed.
• It is important to treat the underlying cause; however, most coughs are self-limiting where only supportive therapies, such as steam inhalation, saltwater gargles, antipyretics (acetaminophen) and cough suppressants are needed.

Although a quick fix might be tempting, simply slowing down could be helpful, which means, sometimes, taking a day off to get some rest. People should also drink enough water to stay hydrated since that can help break up any thick mucus that is causing the cough.

What are the causes of a stubborn cough?

A cough accompanying a cold or the flu is normal. It helps clear the airways of anything impeding normal breathing. However, chronic or severe coughing may be a sign of an underlying health condition, which may include:

• An infection
  • Common cold, pneumonia, flu, fungal infections and tuberculosis.
• Chronic obstructive pulmonary disease (COPD)
  • A chronic condition that causes frequent bouts of coughing and is most common with emphysema and chronic bronchitis.
• Asthma
  • A condition in which your airways become narrow and swollen and mucus production is increased.
• Postnasal drip
  • Your cough reflex exists to clear your airways of any obstructions.
  • Postnasal drip, also called upper airway cough syndrome, is marked by an overproduction of mucus that often drips down the back of your throat, which (constantly) triggers the cough reflex.
• Cystic fibrosis (CF)
  • A serious, inherited disease that thickens the mucus, causing it to become sticky and plug up your airways, resulting in a chronic cough.
• Gastroesophageal reflux disease (GERD)
  • If your chronic cough is accompanied by heartburn or a sour taste in your mouth, it could be a symptom of acid reflux disease, GERD.
  • GERD is marked by stomach acid flowing up from your stomach to the throat via the esophagus, irritating the esophagus and causing a chronic cough.
  • The cough can worsen GERD, which in turn worsens the cough until you seek medical treatment.
• Allergies
  • An allergy-related cough results from your body’s response to an allergen, an otherwise harmless substance (in most cases) that triggers your immune system.
  • Seasonal allergies are extremely common, triggered by things such as dust and pet dander.
  • Coughs from allergies tend to be dry and persistent, or they may worsen during certain seasons or in different environments.

When should I see a doctor?

While most coughs can take three weeks or less to settle down, some stubborn coughs may be a sign of a more serious issue.  In those cases, visit your doctor if:

• You feel more unwell than you would expect.
• The cough started after you have choked on something.
• You are coughing up blood.
• Your cough is not getting better within three days.
• You have chest or shoulder pain in addition to your cough.
• You are finding it difficult to breathe.
• You are losing weight for no apparent reason.
• Your voice becomes hoarse and stays that way even after the cough has settled.
• You notice new neck lumps or swellings above your collarbones.

What is penicillin V? What are the uses for penicillin V (phenoxymethyl penicillin)?

• Penicillin V is effective for treatment of laryngitis, bronchitis, pneumonia, and soft tissue and skin infections caused by susceptible bacteria.
• It also is used for preventing recurrence of rheumatic fever and chorea (a disorder of uncontrolled movement of the body).
• Only mild to moderate infections are treated with oral penicillin V.
• Patients with more severe infections are given penicillin by injection.

Is penicillin V (phenoxymethyl penicillin) available as a generic drug?

Yes

Do I need a prescription for penicillin V (phenoxymethyl penicillin)?

Yes

What are the side effects of penicillin V (phenoxymethyl penicillin)?

Common side effects of penicillin V include:

• nausea,
• vomiting,
• diarrhea,
• abdominal pain,
• fever,
• black hairy tongue,
• eosinophilia,
• rash,
  and
• itching.

Patients
with a history of allergic reactions to other penicillins should not receive
penicillin V. Persons who are allergic to the cephalosporin class of
antibiotics, which are related to the penicillins, for example,
cefaclor (Ceclor),
cephalexin (Keflex),
and cefprozil (Cefzil),
may or may not be allergic to penicillins.

Serious but rare reactions include:

• seizures,
• hemolytic anemia,
• super infection,
• reduced kidney function,
• severe
  allergic reactions (anaphylaxis),
  and
• low platelet or red blood cell count.

Penicillins can alter the normal
bacteria in the colon and encourage overgrowth of some bacteria such as

Clostridium difficile which causes inflammation of the colon (pseudomembranous colitis). Patients who develop signs of pseudomembranous colitis after starting
penicillin (diarrhea, fever, abdominal pain, and possibly
shock) should contact
their doctor immediately.

QUESTION

Bowel regularity means a bowel movement every day.
See Answer

What is the dosage for penicillin V (phenoxymethyl penicillin)?

The usual adult dose of penicillin V is 125 to 500 mg every 6-8
hours.

Which drugs or supplements interact with penicillin V (phenoxymethyl penicillin)?

:

• Probenecid (Benemid)
  causes an increase in the level of penicillin in the blood by reducing the
  elimination of penicillin by the kidneys. In fact, sometimes probenecid is
  combined with penicillin so that a smaller amount of penicillin results in
  higher blood levels.
• Penicillin may reduce the effectiveness of BCG live vaccine
  (used for
  prevention of
  tuberculosis) or
  live typhoid vaccine. Penicillin
  therapy should be completed before giving live bacterial vaccines.

Is penicillin V (phenoxymethyl penicillin) safe to take if I’m pregnant or breastfeeding?

:

• Penicillin is considered safe
  during pregnancy.
• Penicillin is excreted in
  breast milk and may cause
  diarrhea or
  allergic responses in
  nursing infants.
  If penicillin is used while nursing, the potential benefit of penicillin for the
  mother should be weighed against the potential risk of side effects in the
  infant. Penicillin is used for treating infections in infants.

What else should I know about penicillin V (phenoxymethyl penicillin)?

What preparations of penicillin V (phenoxymethyl penicillin) are available?

Tablets: 250 and 500 mg. Powder: 125 and 250 mg/5 mL.

How should I keep penicillin V (phenoxymethyl penicillin) stored?

• Tablets should be stored between 15 C and 30 C (59 and 86 F).
• After
  mixing with water, the solution should be kept refrigerated and can be used for
  up to 14 days after it is reconstituted by the pharmacist.
• It must be shaken
  before each use and should be kept well-sealed.

What is norfloxacin? What is norfloxacin used for?

Norfloxacin is a fluoroquinolone antibiotic. Other
fluoroquinolones include ciprofloxacin (Cipro), levofloxacin (Levaquin), and
ofloxacin (Floxin). Norfloxacin works by blocking DNA gyrase enzyme, which is
responsible for production and repair of bacterial DNA. Blocking of DNA gyrase
leads to bacteria death and prevents worsening of infection. Norfloxacin treats
infections caused by gram-positive and gram-negative bacteria like Enterococcus
faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus
saprophyticus, Streptococcus agalactiae, Citrobacter freundii, Enterobacter
aerogenes, Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia,
Neisseria gonorrhoeae, Proteus mirabilis, Proteus vulgaris, Pseudomonas
aeruginosa, and Serratia marcescens. FDA approved the brand name norfloxacin
(Noroxin) in October 1986.

What brand names are available for norfloxacin?

Noroxin

Is norfloxacin available as a generic drug?

Not in US, in Canada

Do I need a prescription for norfloxacin?

Yes

What are the side effects of norfloxacin?

Side effects of norfloxacin are nausea, stomach cramps,
dizziness, headache, abdominal pain, diarrhea,
abnormal heart beats, and
photosensitivity
(sun sensitivity).

Norfloxacin as well as other antibiotics in the fluoroquinolone class of
antibiotics, has been associated with tendinitis and even rupture of tendons,
particularly the
Achilles tendon. Many antibiotics, including norfloxacin, can
alter the normal bacteria in the colon and encourage overgrowth of a bacterium
responsible for the development of inflammation of the colon, (C. difficile
caused
pseudomembranous colitis). Patients who develop signs of pseudomembranous
colitis after starting norfloxacin (diarrhea, fever, abdominal pain, and
possibly shock) should contact their
doctor immediately.

Fluoroquinolones have neuromuscular blocking activity and can worsen muscles
weakness in individuals with myasthenia gravis. They also worsen low blood
glucose levels when combined with sulfonylureas (for example, glyburide [Micronase,
Diabeta, Glynase, Prestab]).

QUESTION

Bowel regularity means a bowel movement every day.
See Answer

What is the dosage for norfloxacin?

• Uncomplicated
  urinary tract infectionTake 1 tablet (400 mg) by mouth every
  12 hours for 3 days
• Complicated urinary tract infection Take 1 tablet (400 mg) by mouth every 12
  hours for 10 to 21 days.
• For infections caused by
  E. coli, K. pneumoniae, or P.
  mirabilis only. Take 1 tablet (400 mg) by mouth every 12 hours for 7 to 10 days,
  for infections caused by any other bacteria.
• ProstatitisTake 1 tablet (400 mg) by mouth every 12 hours for 28 to 42
  days.
• Gonorrhea Take 2 tablets (800 mg) by mouth as one single dose.

Safe and effective use of norfloxacin is not established in patients under
the age of 18 years.

Note that some organisms are resistant to norfloxacin; organisms should be
tested for susceptibility to this drug.

Which drugs or supplements interact with norfloxacin?

: Norfloxacin should be used with caution with medications
like caffeine, clozapine (Clozaril), ropinorole (Requip), cyclosporine (Neoral,
Sandimmune, Gengraf), theophylline (Theo-24), and tizanidine (Zanaflex) because
norfloxacin can slow down breakdown of these medications in and increase their
levels in the body.

Norfloxacin should be separated from aluminum and magnesium containing
antacids, sucralfate (Carafate), and multivitamins because they can lower
absorption of norfloxacin and reduce its effectiveness. They should be
administered 2 hours before norfloxacin.

Norfloxacin should be used with caution with warfarin (Coumadin) because
norfloxacin can increase the risks of bleeding and
bruising.

Norfloxacin should be used with caution with medications used for treating
abnormal heart beats because it can affect heart rhythm.

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Is norfloxacin safe to take if I’m pregnant or breastfeeding?

It is not known whether norfloxacin enters
breast milk;
therefore, it is best to be cautious before using it in nursing mothers.

What else should I know about norfloxacin?

What preparations of norfloxacin are available?

Tablets: 400 mg

How should I keep norfloxacin stored?

Store norfloxacin tablets between temperatures of 15 C – 30 C (59 F
– 86 F), in a tightly closed container.