COMMON COLD AND INFLUENZA (FLU)

1. Differences

COMMON COLD (demam selesema) Differentiation FLU

1. Rhinovirus Causative agents 1. Influenza A H1N (Swine) & H5N1
2. Coronavirus (bird).
3. Adenovirus 2. Influenza B

Less than 380C Fever High temperature exceed 380C

Very mild Fatigue and malaise Severe and can extend to 3 weeks
Less frequent Sneezing Frequent
Severe Running nose and Mild
watery eyes
None or mild (dry cough) Cough Severe started with dry cough
Chest discomfort Very common and can be severe
None or mild Sore throat Moderate to severe
Mild General aches and Moderate to severe
pain (sakit2 otot)
Mild Headache Moderate to severe

Both cold and flu have different causative agents. However, sign and symptoms might overlap between
patients.

2. Treatments

Viral infection is self-limited and thus, only symptomatic treatment can be given. Besides, it is also not
response to antibiotic therapy.
The main treatments:
1) Antipyretic
2) Nasal decongestant
3) Antihistamine

A. Pharmacological
1) Antipyretic:
 Paracetamol
 Adult: 2 Tabs TDS
 Child
500 mg
Tablet 7-12 y/o: 1 Tabs TDS
3-7 y/o: ½ Tabs TDS
Relieve fever, common cold
650 mg  12 y/o > 1 Tabs QID
and flu, muscular rheumatism,
dysmenorrhea and pain eg.  Child
250 mg / 5 ml headache, toothache 6-12 y/o: 5-10 ml TDS
1-6 y/o: 2.5-5 ml TDS
Suspension
 Child
120 mg / 5 ml 6-12 y/o: 10-20 ml TDS
1-6 y/o: 5-10 ml TDS
Caplet Relieve muscle and joint pain
Panadol Extend SR - 665  Adult: 2 Caps TDS
(back pain and osteoarthritis)
mg Max = 6 Caps/day
& others like Tablet
Panadol Actifast - PCM Post dental operation pain, post  12 y/o > 2 Caps QID
500 mg, Na 173 mg vaccination fever, sore throat, Max = 8 Caps
joint and muscle pain & others
 like Tablet
Panadol Extra - PCM 500  12 y/o > 2 TDS
Migraine & others like Tablet
mg, Caffeine 65 mg Max = 8 Caps
Relief bloating, water weight
(Panadol PCM 500 mg, Pamabrom gain, pain associated with
 2 Caps QID
Menstrual) 25 mg premenstrual, dysmenorrhea &
others like Tablet
 Infant
1-3 month where 4-6 kg:
0.6-0.9 ml (advice from
Fever and mild to moderate doctor)
Oral drop 60 mg / 0.6 ml
pain teething 3-6 month: 0.9-1.2 ml
 Child
6-12 month: 1.2-1.5 ml
1-2 year: 1.5-1.8 ml

 Nasal Decongestant (Topical & Oral)

Topical: Sympathomimetic amines that stimulate adrenergic receptors of blood vessel then produce
constriction of dilated nasal blood vessel.

Inhaler Decongestant (Vasoconstrictor)

Short acting Long acting
Levmetamfetamine Naphazoline HCl  Nasal spray
(Vasoconstrictor) Phenyleprine HCl 1. Xylometazoline 0.1% : Infant and child < 6: 2
Adek bradek  Nasal drop
methamphetamine Brand: 2. Xylometazoline 0.1% : Adult and Child > 6 yrs used 2 drop
or pill kuda/ice 1. Naphcon 3. Xylometazoline 0.05%: Infant & child < 6 yrs used 2 drop
Forte BD.
Brand: Brand:
1. Vicks 1. Otrivin

Topical nasal decongestant can cause  Nasal spray

rhinitis medicamentosa (rebound and
loss of effectivess of the treatment).
How to cater?
1. Slowly withdraw nasal spray
2. Replace nasal decongestant with
saline to irrigate
3. If needed used oral/systemic
decongestant or TOPICAL
corticosteroid
1. Oxymetazoline HCl 0.05% : For child > 6 and adult used
2 sprays BD for every nostril
 Nasal drop
2. Oxymetazoline HCl 0.025% : Child > 1 yr used 1-2 drop
BD
3. 0.01%: Newborn – 4 weeks used 1 drop BD/
1-2 months used 2 drops BD
Brand:
1. Afrin
2. Axcel Oxymetazoline
3. Iliadin
4. Oxymetazoline Wintac
5. Oxy-Nase
Oral decongestant in combination with anti-histamine:

1. Zyrtec-D contain cetirizine HCl 5 mg and pseudoephedrine HCl 120 mg. Dose adult & child > 12
yrs: one tablet BD

2. Clarinase Repetab - loratadine 5 mg and pseudoephedrine 120 mg. Dose adult & child > 12 yrs:
one tablet BD

Other Combination
1. Flucor/ Panadol cold - Paracetamol 500 mg & pseudoephedrine 30 mg adult & child > 12 yrs: 2
Tabs TDS (Max = 8 Tabs sbb pseudoephedrine 240 mg is the maximum dose/day).
2. Panadol Cold Flu- Paracetamol 500 mg & pseudoephedrine 30 mg & chlorpheniramine maleate 2
mg adult & child > 12 yrs: 2 Tabs TDS (Max = 8 Tabs)

1.
Pseudoephedrine HCl
3. Clarinase 24 hr – loratadine 10 mg and pseudoephedrine 240 mg. Dose adult & child > 12 yrs: one
tablet OD
4. Fedac – Triprolidine (anti-histamine) 2.5 mg and pseudoephedrine 60 mg
5. Axcel Tridine (concept double dose Fedac) – In 5 ml contains: Triprolidine 1.25 mg and
pseudoephedrine 30 mg. Dose for adult & child > 12 yrs: 10 ml / 6-12 yrs: 5 ml / 2-5 yrs: 2.5 ml / 6
month-2yrs: 1.25 ml
6. Pharmaniaga Pseudoephedrine - Pseudoephedrine 60 mg and tripolidine 2.5 mg. Adult: 1 Tabs TDS
Child 6-12 yrs: ½ Tabs TDS
Phenylephrine HCl Tussinol-N – In 5 ml content: 1. Child 6-12 yrs: 1 tsp TDS
1. Brompheniramine maleate 2 mg 2. 2-6 yrs: ½ tsp TDS
2. Phenylephrine HCl 5mg 3. Adult: 2 tsp TDS
7.
8.
Phenylpropanolamine HCl

*decongestant is used to constrict the blood vessel at nasal while anti-histamine will reduce itchiness and
runny nose/secretion.

Other combination treatment:

Nasal steroid
 COUGH

Not Productive
Pabron – Carbocisteine 375 mg 2 Tabs TDS
Tablet
Sleepy cough
Drowsy/ Cloperastine HCl 10 mg (ubat batuk
Dry cough 1-2 Tabs TDS
sedative HIJAU)
Productive
Adult & child > 15 yrs: 15 ml
cough Pabron – Carbocisteine 250 mg/5 ml
TDS
(Mucolytic)
Productive
Adult: 3 tablespoon OD.
cough
Mucoease Plus Syrup – In 5 ml content: Child > 5yrs: 3-6 teaspoon
(Mucolytic)
1. Carbocisteine 100 mg OD
+
2. Promethazine 2.5 mg (anti-histamine) Infant > 2 yrs: 1 teaspoon for
Common
every 5 kg OD
cold
Bena Expectorent – In 5 ml content:
1. Diphenhydramine 14 mg
Drowsy/ Productive Adult & child > 12 yrs: 10 ml
2. Ammonium 135 mg
Adult/ Child

sedative cough TDS

3. Sodium citrate 57.5 mg
Suspension/solution

Cough-En (Lintus) – In 5 ml content:

1. Triprolidine 1.25mg
1. Adult & child > 12 yrs:
Dry cough 2. Dextromethorphan HBr 15mg
10 ml TDS
+ 3. Pseudoephedrine HCl 30mg
2. Child 6-12 yrs 5 ml TDS
runny nose/
3. Child 2-5 yrs 2.5 ml TDS
allergic Sedilix – In 5ml content:
/common 1. Dextromethorphan HBr 15mg
*Cannot be used for child less
cold 2. Phenylephrine HCl 5mg
than 2 yrs
3. Promethazine HCl 3.125mg

Productive
Hosolvon DM Elixir – in 5 ml content: 1. Adult & child > 12 yrs:
cough
1. Bromohexine 4 mg 10 ml TDS
+
2. Dextromethorphan HBr 15mg 2. 6-12 yrs: 5 ml
Not Mucolytic
Sleepy 2. Adult & child > 12 yrs:
Resistant Dry Tussidex Forte 10 ml TDS
cough 1. Dextromethorphan HBr 15mg/5ml 3. Child 6-12 yrs 5 ml OD

Antitussive Linkus Cough Syrup (Herbion) 1. Adult: 2 teaspoons TDS

Liquid
Infant

+ 1. Adhatoda vasica 2. Child: 1 teaspoons TDS

Expectorant 2. Glycyrrhiza glabra 3. Infants: ½ teaspoons TDS
+ 3. Piper longum
Decongestant 4. Viola odorata 1 Tbsp = 15 ml

Wet or chesty = productive

Dry or hacking = non-productive

Antitussive Opioid 1. Codeine

(suppress 2. Pholcodeine
cough) Non-opioid 1. Dextromethorphan
2. Cloperastine
Dry cough Antihistamine 1. First generation of anti-histamine has higher antitussive:
 - Triprolidine
- Promethazine
- Diphenhydramine
- Brompheniramine
Topical 1. Camphor
2. Menthol
(applied thick layer at throat and chest)
Protussive Expectorant 1. Guaifenesin
(expectorant) 2. Ammonium chloride
3. Sodium citrate
Wet cough 4. Ipecacuanha
Mucolytic 1. Bromohexine
2. Ambroxol
3. Carbocisteine