Author: Rupal Patel Mansukhani, PharmD, and Mary Barna Bridgeman, PharmD, BCPS, CGP
Case 1—Infant Care
Rupal Mansukhani, PharmD Mary Bridgeman, PharmD
SN comes to the pharmacy looking for something to help her 5-month-old daughter, who hasn’t been feeling well and is acting fussy. SN says her daughter has decreased her milk intake from 5 oz every 3 hours to 3 oz every 3 hours and is not eating any of her solids. SN thinks her daughter may have a cold. upon further questioning, she says that her daughter has been congested for 2 days and has had a fever of 102°F for 1 day. SN has not given her daughter anything for her congestion yet, but is giving her 1 dropperful of tylenol every 4 to 6 hours for the fever. What would you recommend to treat the daughter’s congestion?
Because the daughter’s symptoms are suggestive of a common cold, you need to assess whether she is a candidate for self-treatment. Given that the daughter is an infant younger than 9 months and that she has a fever greater than 101.5°F, she is not a candidate for self-treatment. (To ensure accurate temperature readings, it is important to educate SN on the proper protocol. For infants, it is recommended that the parent take a rectal temperature to get the most accurate reading.) You should also advise SN not to exceed 5 doses of Tylenol in a 24-hour period.
It is also important to emphasize that SN should not give her daughter ibuprofen until she is 6 months of age and that once her daughter is 6 months of age, it is important not to interchange ibuprofen and acetaminophen. The American Academy of Pediatrics recommends against alternating ibuprofen and acetaminophen due to the risk that medication will be given too frequently, that many different available concentrations will cause confusion, and that acetaminophen and ibuprofen are often mixed with other cold and cough preparations. in addition, there is no evidence that combining the medications achieves a more rapid decrease in fever than monotherapy.2
Case 2—Dry Cough
ML is a 48-year-old woman who comes to the pharmacy complaining of a dry cough. She wants to know if there is anything available over the counter for her cough. Upon further questioning, ML says she has been coughing nonstop and it is interfering with her work as an actress. She says she is auditioning for a new Broadway musical and needs to stop coughing prior to her next audition, which is scheduled for next week. She claims her audition today went horribly because she kept coughing while she performed. ML’s symptoms include nasal congestion and a sore throat. She says she has no fever. She has no medical conditions and is not taking any medication. What OTC treatment would you recommend for her cough?
ML is eligible to self-treat her cold. Because she has no medical conditions and has tried no treatment so far, you can recommend a decongestant such as phenylephrine for her nasal congestion. (However, any nasal decongestant would be acceptable.)
It is also important to educate her to use nonpharmacologic approaches, such as using saline drops and a humidifier to help with her congestion, staying hydrated by drinking at least 8 glasses of water per day, and getting plenty of rest.
For the postnasal drip that appears to be causing her sore throat and cough, you can recommend a first-generation antihistamine such as diphenhydramine. Because ML is auditioning for a musical, it is important to educate her about the drowsiness that first-generation antihistamines can cause and advise her not to take antihistamines just before her audition.
Dr. Mansukhani is a clinical pharmacist in South Plainfield, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University. Dr. Bridgeman is an internal medicine clinical pharmacist in Trenton, New Jersey, and clinical assistant professor, Ernest Mario School of Pharmacy, Rutgers University.
National Institute of Allergy and Infectious Diseases. www.niaid.nih.gov/topics/commoncold/Pages/symptoms.aspx. Updated October 10, 2012. Accessed October 20, 2012.
Mayoral CE, Marino RV, Rosenfeld W, et al. Alternating antipyretics: is this an alternative? Pediatrics. 2000;105:1009-1012.
Tietze K. Cough. In. Berardi R, Ferreri S, Hume A, et al, eds. Handbook of Nonprescription Drugs. Washington DC: American Pharmacists Association; 2009:204.