Share This Article:
Review Paper

Rationale for Treatment of Common Cold and Flu with Multi-Ingredient Combination Products for Multi-Symptom Relief in Adults

Abstract Full-Text HTML Download Download as PDF (Size:1170KB) PP. 73-82
DOI: 10.4236/ojrd.2014.43011    6,759 Downloads   8,695 Views   Citations

ABSTRACT

This up-to-date overview will look at the rationale for the recommendation of combination products for multi-symptom relief of common cold and flu. Common cold and flu are defined by their multi-symptom nature with data showing a variety of symptoms reported simultaneously each day over the first six days of illness. Multi-ingredient combination products for multi-symptom relief are formulated to safely, simply, and simultaneously treat multiple symptoms when used as directed. The rationale for the formulation combination products for common cold and flu is therefore practical, logical and reasonable. No evidence has been found that multi-symptom relief medicines are inherently less safe than single-active ingredient medicines. Multi-symptom relief combination products containing several active ingredients provide a safe, effective, cost-effective, and convenient way of treating the multiple symptoms of common cold and flu, when used as directed. This therapy requires some special information for the patient to be provided by the physician and the pharmacist.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Eccles, R. , Fietze, I. and Rose, U. (2014) Rationale for Treatment of Common Cold and Flu with Multi-Ingredient Combination Products for Multi-Symptom Relief in Adults. Open Journal of Respiratory Diseases, 4, 73-82. doi: 10.4236/ojrd.2014.43011.

References

[1] Johnston, S. and Holgate, S. (1996) Epidemiology of Viral Respiratory Infections. In: Myint, S. and Taylor-Robinson, D., Eds., Viral and Other Infections of the Human Respiratory Tract, Chapman & Hall, London, 1-38.
http://dx.doi.org/10.1007/978-94-011-7930-0_1
[2] Kirkpatrick, G.L. (1996) The Common Cold. Primary Care, 23, 657-675.
http://dx.doi.org/10.1016/S0095-4543(05)70355-9
[3] Grijalva, C.G., Nuorti, J.P. and Griffin, M.R. (2009) Antibiotic Prescription Rates for Acute Respiratory Tract Infections in US Ambulatory Settings. JAMA, 302, 758-766.
http://dx.doi.org/10.1001/jama.2009.1163
[4] Monto, A.S. and Sullivan, K.M. (1993) Acute Respiratory Illness in the Community. Frequency of Illness and the Agents Involved. Epidemiology Infection, 110, 145-160.
http://dx.doi.org/10.1017/S0950268800050779
[5] Doyle, W. and Cohen, S. (2009) Etiology of the Common Cold: Modulating Factors. In: Eccles, R. and Weber, O., Eds., Common Cold, Birkhauser Verlag, Basel, 149-186.
http://dx.doi.org/10.1007/978-3-7643-9912-2_6
[6] Sirois, J. and Ferreri, S. (2013) OTC Combination Products in Pharmacist-Assisted Self-Care. Pharmacy Today, 49-53.
[7] Weber, O. (2009) The Role of Viruses in the Etiology and Pathogenesis of Common Cold. In: Eccles, R. and Webber, O., Eds., Common Cold, Birkhauser Verlag, Basel, 107-147.
http://dx.doi.org/10.1007/978-3-7643-9912-2_5
[8] Heikkinen, T. and Jarvinen, A. (2003) The Common Cold. Lancet, 361, 51-59.
http://dx.doi.org/10.1016/S0140-6736(03)12162-9
[9] Zambon, M.C., Stockton, J.D., Clewley, J.P. and Fleming, D.M. (2001) Contribution of Influenza and Respiratory Syncytial Virus to Community Cases of Influenza-Like Illness: An Observational Study. Lancet, 358, 1410-1416.
http://dx.doi.org/10.1016/S0140-6736(01)06528-X
[10] Eccles, R. (2009) Mechanisms of Symptoms of Common Cold and Flu. In: Eccles, R. and Webber, O., Eds., Common Cold, Birkhauser Verlag, Basel, 23-45.
http://dx.doi.org/10.1007/978-3-7643-9912-2_2
[11] Punpanich, W. and Chotpitayasunondh, T. (2012) A Review on the Clinical Spectrum and Natural History of Human Influenza. International Journal of Infectious Diseases, 16, e714-e723.
http://dx.doi.org/10.1016/j.ijid.2012.05.1025
[12] Ruuskanen, O., Lahti, E., Jennings, L.C. and Murdoch, D.R. (2011) Viral Pneumonia. Lancet, 377, 1264-1275.
http://dx.doi.org/10.1016/S0140-6736(10)61459-6
[13] Eccles, R. (2005) Understanding the Symptoms of the Common Cold and Influenza. Lancet Infectious Diseases, 5, 718-725.
http://dx.doi.org/10.1016/S1473-3099(05)70270-X
[14] Eccles, R. (2013) Is the Common Cold a Clinical Entity or a Cultural Concept? Rhinology, 51, 3-8.
[15] Jackson Allen, P. and Simenson, S. (2013) Management of Common Cold Symptoms with Over-the-Counter Medications: Clearing the Confusion. Postgraduate Medicine, 125, 73-81.
http://dx.doi.org/10.3810/pgm.2013.01.2607
[16] Georgitis, J.W. (1993) Nasopharyngitis, Pharyngitis, and Tonsillitis. Immunology And Allergy Clinics of North America, 13, 109-118.
[17] Chan, T.V. (2010) The Patient with Sore Throat. Medical Clinics of North America, 94, 923-943.
http://dx.doi.org/10.1016/j.mcna.2010.06.001
[18] Monto, A.S., Gravenstein, S., Elliott, M., Colopy, M. and Schweinle, J. (2000) Clinical Signs and Symptoms Predicting Influenza Infection. JAMA Internal Medicine, 160, 3243-3247.
http://dx.doi.org/10.1001/archinte.160.21.3243
[19] WHO Expert Committee on Specifications for Pharmaceutical Preparations (2005) Guidelines for Registration of Fixed-Dose Combination Medicinal Products. 39th Report, WHO Technical Report Series, No. 929, Annex 5 Combination Medicinal Products 2005, WHO, Geneva.
[20] Jackson, G., Dowling, H., Spiesman, I. and Boand, A. (1958) Transmission of the Common Cold to Volunteers under Controlled Conditions. 1 The Common Cold as a Clinical Entity. JAMA Internal Medicine, 101, 267-278.
http://dx.doi.org/10.1001/archinte.1958.00260140099015
[21] Tyrrell, D.A., Cohen, S. and Schlarb, J.E. (1993) Signs and Symptoms in Common Colds. Epidemiology and Infection, 111, 143-156.
http://dx.doi.org/10.1017/S0950268800056764
[22] Turner, R.B., Witek, T.J. and Riker, D.K. (1996) Comparison of Symptom Severity in Natural and Experimentally Induced Colds. American Journal of Rhinology, 10, 167-172.
http://dx.doi.org/10.2500/105065896781794888
[23] Gwaltney Jr., J.M., Hendley, J.O., Simon, G. and Jordan Jr., W.S. (1967) Rhinovirus Infections in an Industrial Population. II. Characteristics of Illness and Antibody Response. JAMA, 202, 494-500.
http://dx.doi.org/10.1001/jama.1967.03130190100014
[24] No Authors Listed (1961) A Multi-Ingredient Tablet for the Symptomatic Relief of the Common Cold. Practitioner, 187, 364-366.
[25] No Authors Listed (1967) Multi-Ingredient Cold Remedies. Practitioner, 198, 436-441.
[26] Bjerrum, O.J., Gautam, Y., Bjerrum, E.J., Schmiegelow, M. and Boonen, H.C. (2013) Medicines Combinations Options and Regulatory Hurdles. European Journal of Pharmaceutical Sciences: Official Journal of the European Federation for Pharmaceutical Sciences, 49, 659-663.
http://dx.doi.org/10.1016/j.ejps.2013.04.028
[27] Bangalore, S., Kamalakkannan, G., Parkar, S. and Messerli, F.H. (2007) Fixed-Dose Combinations Improve Medication Compliance: A Meta-Analysis. American Journal of Medicine, 120, 713-719.
http://dx.doi.org/10.1016/j.amjmed.2006.08.033
[28] Kelly, C.M. and Buzdar, A.U. (2013) Using Multiple Targeted Therapies in Oncology: Considerations for Use, and Progress to Date in Breast Cancer. Drugs, 73, 505-515.
http://dx.doi.org/10.1007/s40265-013-0044-0
[29] Baser, O., Andrews, L.M., Wang, L. and Xie, L. (2011) Comparison of Real-World Adherence, Healthcare Resource Utilization and Costs for Newly Initiated Valsartan/Amlodipine Single-Pill Combination versus Angiotensin Receptor Blocker/Calcium Channel Blocker Free-Combination Therapy. Journal of Medical Economics, 14, 576-583.
http://dx.doi.org/10.3111/13696998.2011.596873
[30] Bashir, S., Sherwani, M.U., Shabbir, I. and Batool, A. (2011) Efficacy of Fix-Dose Combination (Atorvastatin and Amlodipine) in Treatment of Uncontrolled Hypertension and Dyslipidemia. Journal of Ayub Medical College, Abbottabad: JAMC, 23, 97-100.
[31] Bangsberg, D.R., Ragland, K., Monk, A. and Deeks, S.G. (2010) A Single Tablet Regimen Is Associated with Higher Adherence and Viral Suppression than Multiple Tablet Regimens in HIV+ Homeless and Marginally Housed People. AIDS, 24, 2835-2840.
http://dx.doi.org/10.1097/QAD.0b013e328340a209
[32] Mantzaris, G.J., Petraki, K., Archavlis, E., Amberiadis, P., Christoforidis, P., Kourtessas, D., Chiotakakou, E. and Triantafyllou, G. (2002) Omeprazole Triple Therapy versus Omeprazole Quadruple Therapy for Healing Duodenal Ulcer and Eradication of Helicobacter Pylori Infection: A 24-Month Follow-Up Study. European Journal of Gastroenterology & Hepatology, 14, 1237-1243.
http://dx.doi.org/10.1097/00042737-200211000-00012
[33] Di Monda, V., Nicolodi, M., Aloisio, A., Del Bianco, P., Fonzari, M., Grazioli, I., et al. (2003) Efficacy of a Fixed Combination of Indomethacin, Prochlorperazine, and Caffeine versus Sumatriptan in Acute Treatment of Multiple Migraine Attacks: A Multicenter, Randomized, Crossover Trial. Headache, 43, 835-844.
http://dx.doi.org/10.1046/j.1526-4610.2003.03161.x
[34] Eccles, R. (2009) Over the Counter Medicines for Colds. In: Eccles, R. and Webber, O., Eds., Common Cold, Birkhauser Verlag, Basel, 249-273.
http://dx.doi.org/10.1007/978-3-7643-9912-2_12
[35] Eccles, R. and Voelker, M. (2013) Analgesic and Decongestant Efficacy of the Combination of Aspirin with Pseudoephedrine in Patients with Symptoms of Upper Respiratory Tract Infection. Clinical Pharmacology in Drug Development, 3, 118-125.
[36] Loose, I. and Winkel, M. (2004) Clinical, Double-Blind, Placebo-Controlled Study Investigating the Combination of Acetylsalicylic Acid and Pseudoephedrine for the Symptomatic Treatment of Nasal Congestion Associated with Common Cold. Arzneimittel-Forschung, 54, 513-521.
[37] Eccles, R., Jawad, M., Jawad, S., Ridge, D., North, M., Jones, E. and Burnett, I. (2006) Efficacy of a Paracetamol-Pseudoephedrine Combination for Treatment of Nasal Congestion and Pain-Related Symptoms in Upper Respiratory Tract Infection. Current Medical Research and Opinion, 22, 2411-2418.
http://dx.doi.org/10.1185/030079906X154105
[38] Eccles, R., Pedersen, A., Regberg, D., Tulento, H., Borum, P. and Stjarne, P. (2007) Efficacy and Safety of Topical Combinations of Ipratropium and Xylometazoline for the Treatment of Symptoms of Runny Nose and Nasal Congestion Associated with Acute Upper Respiratory Tract Infection. American Journal of Rhinology, 21, 40-45.
http://dx.doi.org/10.2500/ajr.2007.21.2902
[39] Salisbury-Afshar, E. (2012) Oral Antihistamine/Decongestant/Analgesic Combinations for the Common Cold. American Family Physician, 86, 812-813.
[40] De Sutter, A.I., Van Driel, M.L., Kumar, A.A., Lesslar, O. and Skrt, A. (2012) Oral Antihistamine-Decongestant-Analgesic Combinations for the Common Cold. Cochrane Database of Systematic Reviews, 2, Article ID: CD004976.
[41] Cohen, S., Doyle, W.J., Alper, C.M., Janicki-Deverts, D. and Turner, R.B. (2009) Sleep Habits and Susceptibility to the Common Cold. JAMA Internal Medicine, 169, 62-67.
http://dx.doi.org/10.1001/archinternmed.2008.505
[42] Simpson, N. and Dinges, D.F. (2007) Sleep and Inflammation. Nutrition Reviews, 65, S244-S252.
http://dx.doi.org/10.1301/nr.2007.dec.S244-S252
[43] Kashyap, K.C., Nissen, L.M., Smith, S.S. and Kyle, G. (2014) Management of Over-the-Counter Insomnia Complaints in Australian Community Pharmacies: A Standardized Patient Study. International Journal of Pharmacy Practice, 22, 125-134.
http://dx.doi.org/10.1111/ijpp.12052
[44] Bjornsdottir, I., Einarson, T.R., Guethmundsson, L.S. and Einarsdottir, R.A. (2007) Efficacy of Diphenhydramine against Cough in Humans: A Review. Pharmacy World & Science, 29, 577-583.
[45] Eccles, R., Vancauwenberge, P., Tetzloff, W. and Borum, P. (1995) A Clinical Study to Evaluate the Efficacy of the Antihistamine Doxylamine Succinate in the Relief of Runny Nose and Sneezing Associated with Upper Respiratory- Tract Infection. Journal of Pharmacy and Pharmacology, 47, 990-993.
http://dx.doi.org/10.1111/j.2042-7158.1995.tb03283.x
[46] Doyle, W.J., McBride, T.P., Skoner, D.P., Maddern, B.R., Gwaltney, J.M. and Uhrin, M. (1988) A Double-Blind, Placebo-Controlled Clinical Trial of the Effect of Chlorpheniramine on the Response of the Nasal Airway, Middle Ear and Eustachian Tube to Provocative Rhinovirus Challenge. Journal of Pediatric Infectious Disease, 7, 229-238.
http://dx.doi.org/10.1097/00006454-198803000-00033
[47] Picon, P.D., Costa, M.B., Da Veiga Picon, R., Fendt, L.C., Suksteris, M.L., Saccilotto, I.C., Dornelles, A.D. and Schmidt, L.F.C. (2013) Symptomatic Treatment of the Common Cold with a Fixed-Dose Combination of Paracetamol, Chlorphenamine and Phenylephrine: A Randomized, Placebo-Controlled Trial. BMC Infectious Diseases, 13, 556.
http://dx.doi.org/10.1186/1471-2334-13-556
[48] Seagrave, J., Albrecht, H.H., Hill, D.B., Rogers, D.F. and Solomon, G. (2012) Effects of Guaifenesin, N-Acetylcy- steine, and Ambroxol on MUC5AC and Mucociliary Transport in Primary Differentiated Human Tracheal-Bronchial Cells. Respiratory Research, 13, 98.
http://dx.doi.org/10.1186/1465-9921-13-98
[49] Fan, Y., Ji, P., Leonard-Segal, A. and Sahajwalla, C.G. (2013) An Overview of the Pediatric Medications for the Symptomatic Treatment of Allergic Rhinitis, Cough, and Cold. Journal of Pharmaceutical Sciences, 102, 4213-4229.
http://dx.doi.org/10.1002/jps.23720
[50] Mizoguchi, H., Wilson, A., Jerdack, G.R., Hull, J.D., Goodale, M., Grender, J.M. and Tyler, B.A. (2007) Efficacy of a Single Evening Dose of Syrup Containing Paracetamol, Dextromethorphan Hydrobromide, Doxylamine Succinate and Ephedrine Sulfate in Subjects with Multiple Common Cold Symptoms. International Journal of Clinical Pharmacology and Therapeutics, 45, 230-236.
http://dx.doi.org/10.5414/CPP45230
[51] Hartley, V. (2003) Overdose of Cough and Cold Remedies. Emergency Nurse: The Journal of the RCN Accident and Emergency Nursing Association, 10, 20-25.
http://dx.doi.org/10.7748/en2003.02.10.9.20.c1091
[52] Janin, A. and Monnet, J. (2014) Bioavailability of Paracetamol, Phenylephrine Hydrochloride and Guaifenesin in a Fixed-Combination Syrup versus an Oral Reference Product. Journal of International Medical Research, 42, 347-359.
http://dx.doi.org/10.1177/0300060513503762
[53] Boudreau, D.M., Wirtz, H., Von Korff, M., Catz, S.L., St John, J. and Stang, P.E. (2013) A Survey of Adult Awareness and Use of Medicine Containing Acetaminophen. Pharmacoepidemiology and Drug Safety, 22, 229-240.
http://dx.doi.org/10.1002/pds.3335
[54] Krenzelok, E.P. (2009) The FDA Acetaminophen Advisory Committee Meeting—What Is the Future of Acetaminophen in the United States? The Perspective of a Committee Member. Clinical Toxicology, 47, 784-789.
http://dx.doi.org/10.1080/15563650903232345
[55] Raal, A., Volmer, D., Soukand, R., Hratkevits, S. and Kalle, R. (2013) Complementary Treatment of the Common Cold and Flu with Medicinal Plants—Results from Two Samples of Pharmacy Customers in Estonia. PLoS ONE, 8, Article ID: e58642.
http://dx.doi.org/10.1371/journal.pone.0058642
[56] Jiao, Y., Liu, J.P., Jiang, L.D., Liu, Q.Q., Li, X.L., Zhang, S.N., Zhaog, B.X. and Wang, T.F. (2013) Guidelines on Common Cold for Traditional Chinese Medicine Based on Pattern Differentiation. Journal of Traditional Chinese Medicine, 33, 417-422.
http://dx.doi.org/10.1016/S0254-6272(13)60141-7
[57] Passioti, M., Maggina, P., Megremis, S. and Papadopoulos, N.G. (2014) The Common Cold: Potential for Future Prevention or Cure. Current Allergy and Asthma Reports, 14, 413.
http://dx.doi.org/10.1007/s11882-013-0413-5

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.