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Allergic rhinitis - seasonal history of itching in nose, roof of mouth, throat, and eyes; increased tearing,
sneezing and watery discharge; sore throat due to postnasal drip (granular appearance to posterior pharynx);
nasal membranes swollen and red.
Irritant rhinitis - non-seasonal history of exposure to irritant, rhinorrhea without ocular symptoms or sore
throat.
Influenza - more systemic symptoms than cold, including muscle aches, severe headache, chills, and higher
fever to 103°F.
Atypical pneumonia (See Pneumonia) - fatigue, mild respiratory symptoms.
Mononucleosis - positive Monospot; longer illness; higher fever, chills, malaise, sore throat, and swollen
cervical lymph nodes.
Sinusitis - tender sinuses; red, swollen nasal membranes; green or yellow discharge from nose and throat;
can follow a cold.
Rubeola - characteristic rash; Koplik’s spots on mucous membranes; seen typically in children but can attack
non-immune adults.
Mumps - seen typically in children but can attack non-immune adults; swollen salivary glands.
Pertussis - characteristic whooping cough; seen typically in children but can attack non-immune adults.
Diphtheria - seen typically in children but can attack non-immune adults; gray membrane maybe seen on
pharynx.
Adenovirus - fever, pharyngitis, and/or conjunctivitis; usually in epidemics in non-immune recruits or displaced
persons
Strep Pharyngitis - palatal petechiae, red beefy uvula, and scarlatiniform rashes are typical for Group A
streptococcal pharyngitis.
Gonococcal Pharyngitis - often asymptomatic, but may have sore red throat, painful swallowing and history
of exposure
Plan:
Treatment
- See appropriate sections for treatment of pneumonia, infectious mononucleosis, sinusitis and other
illnesses that present similarly to cold/flu. - Treat cold symptomatically: Rest; fluids (higher “insensible” losses due to fever); acetaminophen; warm,
salt water gargles (sore throat); warm steam from a tea kettle or shower, and saline nasal drops (nasal
congestion); no tobacco and alcohol products; hot chicken soup. - Antibiotics: Only indicated in patients that may have or are at high risk for a secondary bacterial infection
(see pneumonia). - Moderate to severe nasal congestion: Nasal ipratropium bromide (nasal Atrovent 0.06% in adults, 0.03%
in children) tid or q hs 2 sprays/nostril has been shown to reduce local symptoms and shorten duration of
rhinorrhea symptoms by one day. Oxymetazoline (e.g., Afrin) nasal spray 0.05% solution (use for
no more 3 days, or just at night, to avoid rebound congestion) - adults and children ages 6 and up: 1-3
sprays/nostril q 12 hrs. Pseudoephedrine tabs or liquid –Children 6-12 years: 30 mg po q 6 hours,
Children 2-6 years: 15 mg q 6 hours, Adults: 60 mg po q 6 hours. - Allergic rhinitis: Diphenhydramine - Adults and children over 12: 25-50 mg po tid/qid; children under 12:
5 mg/kg/day po in divided doses qid. - Irritant rhinitis: Use saline nose drops to lavage nasal mucosa, followed by pseudoephedrine 30-60mg po
q4-6h to decrease mucus membrane swelling. - Cough: See Symptom: Cough.
Nonproductive Cough: dextromethorphan – adults and children over 12: 10-20 mg po q 4h, or 30 mg
q6h; children 6-12 years: 5-10 mg po q 4h or 15 mg q 6-8 hrs; children 2-6 years: 2.5-5 mg po q 4h,
or 7.5 mg every 6-8 hours
Productive Cough: Do not suppress a productive cough unless it interferes with obtaining adequate
rest/sleep or jeopardizes your mission. Codeine q hs can be used for severe cough and will cause
drowsiness (use no more than 3 nights). Expectorants like guaifenesin are often used but have not
been proven effective. - Influenza: Give Relenza (zanamivir) for patients ages 7 years and older within two days of the onset of
symptoms. The drug is less effective in patients whose symptoms are not severe and do not include