Comprehensive Management of Common Cold in Pediatric Patients: Summary Table
Category | Medication/Method | Dosage & Administration | Indication | Age Consideration | Benefits |
Fever and Pain Relief | Paracetamol Drop 100 mg/mL | 0.6 mL every 4-6 hours as needed | Fever and pain relief | Infants and young children | Precise dosage for infants, provides 60 mg per dose |
Paracetamol Syrup 120 mg/5 mL | 5 mL every 4-6 hours as needed | Fever and pain relief | Older children | Effective for reducing fever and relieving pain, provides 120 mg per dose | |
Mucus Clearance | Ambroxol Hydrochloride | 1.5 mL three times a day | Thins and loosens mucus | Infants (consult pediatrician) & older children | Breaks down mucus, making it easier to expel |
Nasal Congestion & Allergy | Chlorpheniramine Maleate (CPM) Syrup | 0.35 mg/kg/day in divided doses | Relief of allergic symptoms like runny nose and sneezing | Children over 1 year | Reduces nasal secretions, not recommended for children under 1 year due to thickening of nasal secretions |
Brompheniramine and Phenylephrine Syrup | 2.5 mL three times a day | Combination of antihistamine and decongestant for congestion | All children | Reduces histamine effects and shrinks nasal blood vessels | |
First-Generation Antihistamines | Depends on the specific medication | Relief of allergic symptoms, runny nose, sneezing, and congestion | All children | Anticholinergic effects reduce nasal secretions, preventing congestion | |
Second-Generation Antihistamines | Depends on the specific medication | Relief of allergic symptoms with less sedation | All children | Fewer sedative and anticholinergic effects | |
Nasal Irrigation | 0.9% Normal Saline Solution (NSS) | 3 mL for nasal irrigation | Moisturizes nasal cavity, relieves congestion, and removes mucus | All ages | Safe, non-pharmacological, clears mucus |
Additional Treatment | Avamys (Fluticasone Furoate) | 1-2 sprays in each nostril once daily | Reduces inflammation in nasal passages, treats allergic rhinitis | Children aged 2 years and older | Controls persistent nasal congestion, runny nose, and sneezing |
Comprehensive Management of Common Cold in Pediatric Patients
To manage the common cold in pediatric patients without using codeine, focus on the following medications and supportive care strategies.
Core Medications and Their Uses
1. Fever and Pain Relief
Paracetamol (Acetaminophen)
Dosage and Administration:
Paracetamol Drop 100 mg/mL:
Dosage: 0.6 mL
Frequency: Every 4-6 hours as needed (เมื่อมีอาการ) for fever or pain relief.
Indication: This concentrated form is typically used for infants or very young children who need a precise dosage based on their weight. Provides 60 mg of paracetamol per dose.
Paracetamol Syrup 120 mg/5 mL:
Dosage: 5 mL
Frequency: Every 4-6 hours as needed (เมื่อมีอาการ) for fever or pain relief.
Indication: This less concentrated syrup is commonly used for slightly older infants and children. Provides 120 mg of paracetamol per dose.
2. Mucus Clearance
Ambroxol Hydrochloride
Dosage: 30 mg/5 mL Syrup, 60 mL
Indication: Mucolytic agent that thins and loosens mucus in the airways, making it easier to clear congestion.
Administration: 1.5 mL three times a day.
Mechanism: Breaks down mucus structure to make it less viscous and easier to expel.
3. Nasal Congestion and Allergy Symptoms
Chlorpheniramine Maleate (CPM) Syrup
Dosage: 2 mg/5 mL
For children over 1 year old: 0.35 mg/kg/day in divided doses.
Indication: Relief of allergic symptoms like runny nose and sneezing.
Note: Not recommended for children under 1 year as it can thicken nasal secretions, which they cannot effectively expel.
Brompheniramine and Phenylephrine Syrup
Dosage: Brompheniramine 2 mg + Phenylephrine 5 mg/5 mL Syrup
Indication: Combination of antihistamine and decongestant for relief of symptoms such as runny nose, sneezing, and nasal congestion.
Administration: 2.5 mL three times a day.
Mechanism: Brompheniramine reduces the effects of natural histamine, while Phenylephrine shrinks blood vessels in the nasal passages.
First-Generation Antihistamines
Examples: Diphenhydramine, Chlorpheniramine, Brompheniramine.
Indications: Relief of allergic symptoms, runny nose, sneezing, and prevention of nasal congestion.
Side Effects: Sedation and anticholinergic effects such as dry mouth, urinary retention, blurred vision, and constipation. These anticholinergic effects can be advantageous in reducing nasal secretions and preventing nasal congestion.
4. Nasal Irrigation
0.9% Normal Saline Solution (NSS)
Usage: 3 mL for nasal irrigation.
Indication: Helps to moisturize the nasal cavity, relieve congestion, and remove mucus.
Use of Avamys (Fluticasone Furoate) in Pediatric Patients
In cases where nasal congestion is severe or associated with allergic rhinitis, Avamys (Fluticasone Furoate) can be an effective addition to the treatment regimen.
Indication: Avamys is a nasal spray used to reduce inflammation in the nasal passages. It is particularly useful in managing symptoms of allergic rhinitis, such as persistent nasal congestion, runny nose, and sneezing, that do not fully resolve with saline irrigation alone.
Usage: Typically, Avamys is administered as one or two sprays in each nostril once daily, depending on the child's age and the severity of symptoms.
Age Consideration: Avamys is recommended for use in children aged 2 years and older. It works by reducing the inflammatory response in the nasal tissues, significantly reducing congestion and other allergic symptoms.
Combining NSS and Avamys for Optimal Symptom Relief
For comprehensive management of nasal congestion in pediatric patients, combining NSS with Avamys can be particularly effective:
Start with NSS Irrigation: Begin treatment with saline irrigation to clear the nasal passages. This helps to remove mucus and provides immediate relief by physically clearing the congestion.
Follow with Avamys: Administer Avamys to address the underlying inflammation after nasal irrigation. By reducing the inflammatory response, Avamys helps to prevent the recurrence of congestion and controls other allergic symptoms.
This combination therapy addresses mechanical obstruction (mucus) and the underlying cause (inflammation), providing thorough and lasting relief from nasal congestion.
Detailed Medication Use by Category
Fever and Pain
Paracetamol (Acetaminophen)
Usage Across Age Groups:
Infants and Young Children:
Paracetamol Drop 100 mg/mL: 0.6 mL every 4-6 hours as needed. Provides 60 mg per dose.
Older Children:
Paracetamol Syrup 120 mg/5 mL: 5 mL every 4-6 hours as needed. Provides 120 mg per dose.
Rationale: Safe for pediatric use, effective for reducing fever and relieving pain.
Nasal Congestion and Allergy
First-Generation Antihistamines
Examples: Diphenhydramine, Chlorpheniramine, Brompheniramine.
Indications: Relief of allergic symptoms, runny nose, sneezing, and prevention of nasal congestion.
Side Effects: Sedation and anticholinergic effects such as dry mouth, urinary retention, blurred vision, and constipation. These anticholinergic effects are beneficial in reducing nasal secretions and preventing nasal congestion.
Second-Generation Antihistamines
Examples: Loratadine, Cetirizine, Fexofenadine.
Indications: Relief of allergic symptoms with less sedation.
Side Effects: Fewer sedative and anticholinergic effects.
Mucolytic Agents
Ambroxol Hydrochloride
Usage Across Age Groups:
Infants: Consult with a pediatrician for specific dosing.
Older Children: Ambroxol Syrup 30 mg/5 mL, 1.5 mL three times a day.
Rationale: Effective in thinning mucus to relieve congestion.
Supportive Care Strategies
Hydration:
Encourage fluid intake to help thin mucus.
Infants: Frequent breastfeeding or formula feeding.
Older Children: Water, soups, and oral rehydration solutions (ORS).
Rest:
Ensure adequate rest to help the body recover.
Nasal Irrigation:
Use saline drops and suctioning to clear nasal passages.
Humidifier:
Use a cool-mist humidifier to maintain moisture in the air and soothe irritated nasal passages and throat.
Why Avoid Codeine in Pediatrics
Risk of Complications: Children cannot effectively blow their noses or expel mucus, making it difficult to clear secretions. Using codeine or other cough suppressants can prevent coughing, which is necessary to clear mucus, potentially worsening infections or other conditions.
Clinical Monitoring and Follow-Up
Monitor Symptoms:
Watch for signs of worsening symptoms, difficulty breathing, or dehydration.
Consult a healthcare provider if symptoms persist beyond 7-10 days or worsen.
Education for Caregivers:
Emphasize the importance of hydration, rest, and appropriate use of medications.
Provide guidance on when to seek further medical care.
Summary
Managing the common cold in pediatric patients involves a combination of medication for symptom relief and supportive care measures. Avoiding codeine is crucial due to its potential risks. The structured approach ensures effective and safe management of symptoms, promoting recovery and preventing complications.
By following these guidelines, you can ensure comprehensive and organized care for pediatric patients with the common cold.
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