Pharmacotherapy of the common cold and influenza

Abstract

Acute upper respiratory tract viral infections are frequently manifested through the common cold and influenza, a mainly mild and a potentially life-threatening clinical syndrome, respectively. Cough and fever (>37.8 °C) in an influenza-like illness, especially in the context of an influenza epidemic, suggest the existence of an influenza syndrome. While the available treatments against the common cold are purely symptomatic (alleviation of sore throat, sneezing, rhinorrhoea, nasal congestion, watery eyes, cough, headache, chilliness and fever), the annual seasonal trivalent vaccine and neuraminidase inhibitors are usually effective measures against influenza. It is hypothesized that frequent colds may reduce the likelihood of infection with influenza and hence be protective. In this vein, the complete prevention may be worse than the inconvenience due to illness and it seems reasonable to try and reduce the public health burden of common cold, but surely not eliminate the common colds altogether. In regard to the influenza, the epidemiological experience warn us that the generally positive results of prophylactic and therapeutic measures during the last pandemic (2009-2010) do not preclude the appearance of some newer genetic reassortments of the virus in the future, possibly threatening the whole population.

Virusne infekcije gornjih disajnih puteva često se manifestuju kao klinički sindromi prehlade (uglavnom blagi), odnosno gripa (potencijalno životno ugrožavajući). Kašalj i groznica (temperatura >37,8 °C) u gripu-sličnom stanju, posebno u uslovima proglašene epidemije gripa, sugerišu postojanje sindroma gripa. Dok su dostupni tretmani protiv prehlade čisto simptomatski (ublažavanje gušobolje, kijanja, curenja nosa, kongestije nosa, suzenja očiju, kašlja, glavobolje, jeze i groznice), godišnja 'sezonska' trovalentna vakcina i inhibitori neuraminidaze su obično efektivne profilaktičke, odnosno terapijske mere protiv gripa. Postavljena je hipoteza da česte prehlade mogu da smanje verovatnoću infekcije virusom gripa i da stoga mogu da imaju zaštitnu ulogu. U tom smislu, potpuna prevencija prehlada bi mogla da ima lošije posledice od neprijatnosti usled same bolesti. Stoga, mere smanjenja opterećenja za javno zdravlje koje nose prehlade jesu potrebne, ali se ne čini racionalnim eventualno eliminisanje prehlade uopšte. U odnosu na grip, epidemiološko iskustvo nas upozorava da generalno pozitivni rezultati profilaktičkih i terapijskih mera tokom poslednje pandemije (2009-2010) ne isključuju mogućnost pojave nekih novih genetskih resortiranja virusa u budućnosti, koja bi mogla da ugroze celu populaciju.