AFP Clinical Answers

Common Cold, IV Fluids for Children, e-Cigarettes, Postpartum Depression, Actinic Keratoses


Am Fam Physician. 2020 Mar 15;101(6):332.

What therapies are effective for the common cold?

Treatments with established effectiveness for cold symptoms in adults are limited to over-the-counter analgesics and decongestants with or without antihistamines, but not antihistamine monotherapy. Over-the-counter cold medications should not be used in children younger than four years because of potential harms and lack of benefit. Antibiotics are ineffective for treatment of the common cold in adults and children and should not be prescribed. Safe and effective treatments for cold symptoms in children include nasal saline irrigation, menthol rub, and honey (for children 12 months and older).

Should hypotonic or isotonic maintenance fluids be provided to hospitalized children?

Maintenance intravenous (IV) fluids provided to children who are acutely ill should be isotonic to prevent hyponatremia. Compared with hypotonic solutions (0.2% or 0.45% sodium chloride), isotonic maintenance fluids (0.9% sodium chloride) reduce hyponatremia with a number needed to treat of 8. Dextrose and potassium chloride can be added to isotonic maintenance fluids without risk of injury from hypertonicity.

How should you counsel patients about e-cigarette use?

e-Cigarettes are not recommended for youth. Youth should be counseled to stop all nicotine and tobacco products, including e-cigarettes. Women should be counseled and assisted with quitting all nicotine and tobacco products, including e-cigarettes, during pregnancy. Adults should be counseled on safe storage practices and symptoms of nicotine poisoning—e-cigarettes, e-cigarette liquids, and all products containing nicotine should be kept out of reach of children. If evidence-based smoking cessation methods are ineffective or the patient does not comply with them, e-cigarettes may be discussed for smoking cessation.

Is cognitive behavior therapy an effective treatment for postpartum depression?

In women with postpartum depression, the addition of cognitive behavior therapy reduces depressive symptoms more effectively than usual care alone (medication and other therapies), with a medium effect size at the end of therapy and a residual small effect size six months later.

What is the best approach to treat multiple actinic keratoses on the head?

The use of topical 5% fluorouracil is most likely to result in successful elimination of actinic keratoses in a field on the head or face based on a randomized controlled trial. Treatment is once weekly for four weeks, which may create a barrier to adherence for some patients. The impact of treatment on longer-term outcomes, such as progression to squamous cell carcinoma, is not known.

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