Complications of the Common Cold in Pediatric Patients

Case

A 5-year-old boy presents to the emergency department complaining of a cough, runny nose, and shortness of breath accompanied by generalized weakness. His symptoms started 2 days ago with a fever. Acetaminophen and diphenhydramine have provided no benefit. Mom asks whether or not he needs antibiotics. The medical team asks for your recommendations.

Answer

The cold is one of the most common illnesses encountered in pediatric practice. The most frequently identified etiology, seen in up to 50% of cases, is rhinoviruses. Other viruses associated with infection include adenoviruses, influenza viruses, enteroviruses, respiratory syncytial virus, and coronaviruses. Presenting symptoms include cough, sneezing, nasal congestion, runny nose, sore throat, fever, sleep disturbances, and fatigue. In general, most colds are mild and self-resolving with treatment limited to supportive care.¹

Severe colds may be complicated by bacterial coinfections such as otitis media, sinusitis, bronchitis, and pneumonia. Concurrent otitis media can occur in up to 30% of preschool-aged children.¹ Pediatric guidelines for these disease states contain recommendations for treatment.^2-4 Antibiotics may be appropriate in certain cases. Patients with reactive airway disease are also at higher risk for these complications, resulting in longer, more severe courses of disease.¹

Recently, a hypervirulent strain of enterovirus has been identified, EV-D68. It has caused illness ranging from mild symptoms to severe respiratory failure, even death. No treatment options are currently available.⁵ Despite activity against other enterovirus strains and case reports supporting their use, capsid binders pleconaril, pocapavir, and vapendavir do not have activity against EV-D68.^5-7

The oral formulation of pleconaril was originally rejected for FDA approval in 2002 due to observed decreased efficacy of oral contraceptives8 and is currently being reevaluated as a nasal spray formulation; pocapavir and vapendavir are also oral agents. Case reports of immunoglobulin use for the treatment of enterovirus infections have also been published.⁹

In this case, the patient received albuterol and oxygen support until symptom resolution. His respiratory viral panel was positive for enterovirus, but was confirmed not to be the EV-D68 strain by the Centers for Disease Control and Prevention. After symptoms resolved, he was referred for further work-up of underlying lung disease due to his severe course of disease.

Leigh Ann Witherspoon, PharmD, is a PGY2 pediatrics specialty pharmacy resident at the University of North Carolina Hospitals and Clinics.

References

1. Pappas DE, Hendley JO. The common cold and decongestant therapy. Pediatr Rev. 2011;32(2):47-55. doi:10.1542/pir.32-2-47.

2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. doi:10.1542/peds.2012-3488.

3. Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262-e280.

4. Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-e76. doi:10.1093/cid/cir531.

5. Centers for Disease Control and Prevention. Non-Polio Enterovirus. Enterovirus D68 for health care professionals. www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html. Accessed October 21, 2014.

6. Tijsma A, Franco D, Tucker S, et al. The capsid binder vapendavir and the novel protease inhibitor SG85 inhibit enterovirus 71 replication. Antimicrob Agents Chemother. 2014;58(11):6990-6992. doi:10.1128/AAC.03328-14.

7. Torres-Torres S, Myers AL, Klatte JM, et al. First use of investigational antiviral drug pocapavir (V-073) for treating neonatal enteroviral sepsis. Pediatr Infect Dis J. 2015;43(1):52-54. doi:10.1097/INF.0000000000000497.

8. Hayden FG, Herrington DT, Coats TL, et al. Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. Clin Infect Dis. 2003;36(12):1523-1532.

9. Bhatt GC, Sankar J, Kushwaha KP. Use of intravenous immunoglobulin compared with standard therapy is associated with improved clinical outcomes in children with acute encephalitis syndrome complicated by myocarditis. Pediatr Cardiol. 2012;33(8):1370-1376. doi:10.1007/s00246-012-0350-4.