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Treatment of Cold Symptoms During Pregnancy
Reviewed By Medical Advisory Board
Rhinoviruses and coronaviruses cause most colds during the fall and winter. Symptoms often include nasal obstruction, discharge, sneezing, sore throat, cough and headache. A low grade fever may be present, but a high fever is more common with the flu. Symptoms lasting for more than two weeks are more likely to be caused by allergies rather than a cold.

General Measures

Fever should always be treated in the pregnant patient with acetaminophen. All patients should be encouraged to drink extra fluids. A cool mist vaporizer may help to relieve congestion.
 

Over the Counter (OTC) Cold Remedies

If the patient wishes to use over-the-counter medications to address symptoms the following may be safely recommended:

Symptom Drug
Hayfever, sneezing, runny nose, itchy watery eyes Chlorpheniramine (Chlortrimeton)
Diphenhydramine (Benadryl)
Clemastine (Tavist Allergy)
Nasal congestion Pseudoephedrine (Sudafed)
(avoid in first trimester)
Cough Dextromethrophan (Robitussin DM sugar free)
Headache or fever: Acetaminophen (Tylenol)

Sinusitis

Colds occasionally lead to secondary bacterial infections of the sinuses, requiring treatment with antibiotics. Sinusitis with purulent nasal drainage and facial pain lasting for more than 7 days may be treated with:

  • Amoxicillin 2-3.5g/d x 7-10d

For penicillin allergic patients:

  • Azithromycin (Zithromax) 500mg PO x 1, then 250mg PO qd x 4d (Z-Pak)

 

REFERENCES:

1. Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol. 1997 100:301-6. 1997. PubMed

2. Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 6th edition,Baltimore, MD: Williams & Wilkins,2002. p285

3. Martinez-Frias ML, Rodriguez-Pinilla E. Epidemiologic analysis of prenatal exposure to cough medicines containing dextromethorphan: no evidence of human teratogenicity. Teratology, 63:38-41. 2001 PubMed

4. Einarson A, Lyszkiewicz D, Koren G. The safety of dextromethorphan in pregnancy : results of a controlled study. Chest. 119:466-9. 2001 PubMed

5. Shaw GM, Todoroff K, Velie EM, Lammer EJ: Maternal illness, including fever, and medication use as risk factors for neural tube defects. Teratology 57:1-7, 1998. PubMed

6. Aselton P, Jick H, Milunsky A, Hunter JR, Stergachis A. First-trimester drug use and congenital disorders. Obstet Gynecol. 65:451-5. 1985. PubMed

7. Snow V, Mottur-Pilson C, Hickner JM Principles of appropriate antibiotic use for acute sinusitis in adults. Ann Intern Med. 20;134:495-7. 2001 PubMed

8. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Sinus and Allergy Health Partnership. Otolaryngol Head Neck Surg. 123(1 Pt 2):5-31. 2000 PubMed



 

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