It's that time of year again…cough and cold season is upon us.
This month's WWYD is a 4 question combo platter of what you might do for coughs and colds.
Case 1
1. Following the busy holiday season, Santa has developed a fever of 103, body aches, chills, dry cough, and mild nausea. His symptoms have been present for 3 days. He tells you, "it hit me like a school of reindeer on Christmas Eve and I still feel miserable 3 days later."
You find no other focus of infection. You strongly suspect influenza (they didn't get flu shots at the North Pole this year.)
What would you do?
a. Check a rapid influenza antigen, if positive start Oseltamivir (SP) 75 mg twice daily for x days
b. Assume influenza, skip influenza testing, and treat empirically with Oseltamivir 75 mg twice daily
c. He is beyond 48 hours from onset. No testing necessary. No treatment beyond supportive (rest, fluids, motrin/tylenol)
d. Check a rapid influenza antigen, start Oseltamivir, encourage patient to enroll in the monoclonal antibody study (if available)
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CASE 2
2. The 'Elf on the Shelf ' feels more like the 'Elf under the Weather'. It all started with sneezing 2 days ago. Now he has terrible congestion. He thinks it is moving into his chest and describes a new sore throat from coughing." He is "MISERABLE" and says; "I'm SURE this is a sinus infection."All of the kids at his most recent assignment (the Johnson household) had been sneezing and coughing. He knew he would catch it from one of them sooner or later. Just his luck, as he is planning a post-holiday cruise to the "tropics."
He says, "you have to help me doc...my plane leaves tomorrow and I have to be feeling better." He tells you that in the past his doctor at the North Pole has treated him with antibiotics.
What would you do?
a. Start him on a 10 day course of Amoxicillin
b. Prescribe a 10 day course of Amoxicillin (but tell him not to take it unless his symptoms fail to improve after 7 days)
c. Prescribe pseudo-ephedrine 30-60 mg every 6 hours as needed for congestion
d. Recommend and over the counter antihistamine for relief of nasal drainage
e. Recommend high dose guaifenisin 1200 mg extended release every 12 hours to promote nasal drainage
f. Recommend Ocean Nasal spray every 1-2 hours to promote nasal drainage
g. Recommend Vitamin C; 1 gram twice a day
h. Recommend Echinacea 300 mg three times a day for 5 days
i. Recommend Afrin Nasal spray every 6 hours for maximum of 3 days (avoid "rhinitis medicamentosa")
j. Prescribe Beclomethasone 42 mcg (or equivalent nasal steroid) twice a day for 2-3 weeks
k. Recommend a massive package of nasal tissue
l. Recommend acetaminophen or ibuprofen as needed for fevers/aches.
m. Recommend Chicken soup, rest, and some TLC from Mrs. Claus
n. Other: please comment below
Most common recommendations:
1. Acetaminophen/Ibuprofen
2. Chicken soup and rest
3. Nasal decongestant
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CASE 3
3. The 'Abominable Snowman' has had a cough for the past 3 weeks. "It just won't go away." He denies fever/chills/sweats. The cough is dry and non-productive. It seems to be worse at the ends of the day (when he wakes up in the morning and at night before sleep.) He admits that he has been more abominable lately and that his friends are even more afraid of him than usual. He swears to you that he is "really a nice guy" and then says; "Doc you've got to help me out...please do something for this cough."
What would you do?
a. Start him on a "z pack"
b. Prescribe him a "z pack" but tell him not to take it unless his symptoms fail to improve over the next 3-5 days.
c. Prescribe an albuterol inhaler: 1-2 puffs every 4 hours as needed for cough
d. Prescribe tessalon perles 200 mg three times a day as needed for cough
e. Prescribe Guaifenisin with codeine cough syrup 5-10 mls every 4-6 hours as needed for cough
f. Recommend Acetaminophen/Ibuprofen as needed for fevers/aches
g. Rest, fluids
h. Encourage patience (and hope he doesn't bite your head off.)
I. Other: please comment below
Most common recommendations:
1. Rest/Fluids
2. Tessalon Perles
3. Acetaminophen/Ibuprofen and Patience
4. Albuterol Inhaler
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Case 4
4. Yukon Cornelius has a BAD SORE THROAT. He thinks it's related to being out in the cold but admits that he has been "licking his pickaxe a bit more than usual." He has felt febrile recently, but is without a fever today. He denies a cough. He is 41 years old. He denies all sexual activity and has only been hanging out with an Elf and a Reindeer who seem healthy. You examine his throat and notice bilateral tonsilar exudate and tenderness in his anterior cervical lymph nodes.
What would you do?
a. Check a rapid strep (no matter what Dr Peterson says) and if positive treat with antibiotics (if negative send for culture and treat accordingly based on results)
b. Calculate his Centor Criteria and follow the recommendations rigidly
c. Give him a Z-Pack and tell him to stop licking his pickaxe
d. Send a throat culture for gonococcus and treat based on results. If positive, offer antibiotic prescription to the elf and the reindeer.
THE END
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Additional therapeutic recommendations for Cough/Cold Season (not officially endorsed by this blog.)
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