Gargle Your Colds Away

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Viewpoint: Gargle Your Colds Away Posted 12/15/2005 http://www.medscape.com/viewarticle/518141?src=mp Charles P. Vega, MD, FAAFP Prevention of Upper Respiratory Tract Infections by Gargling Satomura K, Kitamura T, Kawamura T, et al.Am J Prev Med. 2005;29:302-307. Summary and Commentary As winter approaches, many

patients and physicians will once again test their faith in multiple remedies to prevent and treat the common cold. Unfortunately, well-performed trials have generally demonstrated that effective options for this goal are limited. In a trial involving patients with natural colds and subjects given experimental rhinovirus , neither zinc acetate nor zinc gluconate had any effect on the duration or severity of patients' natural colds. Zinc gluconate was associated with a mild decrease in symptom duration in the experimental cold group, but there was no change in symptom severity.[1] Echinacea is another agent commonly used to either prevent or treat the common cold. In a study of 399 adults who received 1 of 3 different preparations of echinacea either as prophylaxis or treatment for an experimental infection with rhinovirus, none of the echinacea extracts demonstrated significant efficacy over placebo with regard to the severity or symptoms of the engendered

infections.[2] Moreover, echinacea failed to alter markers of disease severity, including the volume of nasal secretions, leukocyte concentrations in nasal-lavage specimens, or the quantitative-virus titer. Behavioral interventions might have a greater impact in the prevention of the common cold. An intervention of a comprehensive infection control program, including required handwashing and standardized bactericidal products for cleaning, has been demonstrated to reduce the overall rate of infection in long-term care facilities compared with usual care.[3] The greatest benefit of the program was demonstrated for respiratory tract infections. Gargling is another behavior thought to reduce the incidence of the common cold, particularly in the Far East. There is some evidence for this conclusion. One trial examined the use of gargling with povidone-iodine among 23 Japanese patients with chronic respiratory disease and repeated infections

of the respiratory tract.[4] Compared with baseline, gargling reduced the rates of respiratory infections. In particular, infections with Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae were reduced by 50%. This study, however, lacked a control group, and the use of gargling was intermittent in some participants. The study under discussion in this Viewpoint was a well-constructed trial of gargling. It was conducted during winter, when upper respiratory tract infections would be most prevalent. All subjects were appropriately accounted for at follow-up, and study compliance was good. In addition, subjects in the gargling and control groups were well-matched at baseline, and statistical analysis was by intention-to-treat. One of the most surprising findings from the current trial is that gargling with plain tap water appears more effective than a povidone-iodine gargle in the prevention of colds. The mechanism

of action for either water or povidone-iodine gargling is not clear in terms of preventing viral infections, but the authors note that the chlorine routinely placed in Japanese drinking water may account for some of the effect. The chlorine levels in the water of the main populations from this study varied between 0.5 and 0.8 mg/dL. There were few study limitations. It was impossible to mask the gargling group from the active intervention, and symptoms were entirely self-reported. In addition, virologic assessments were not made of the study cohort to correlate with symptoms. Research that confirms the validity of safe, inexpensive means to prevent the common cold is always welcome. In the case of the current trial, this research is also high quality. It is still unclear precisely how gargling helps to prevent upper respiratory tract infections, which should give clinicians some pause and researchers more fodder for further studies. For now, the regular use

of gargling seems as legitimate as other, more commonly used means to prevent the common cold. More research that confirms the potential of gargling could lead to more widespread guidelines in favor of gargling. Abstract References Turner RB, Cetnarowski WE. Effect of treatment with zinc gluconate or zinc acetate on experimental and natural colds. Clin Infect Dis. 2000;31:1202-1208. Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. 2005;353:341-348. Makris AT, Morgan L, Gaber DJ, Richter A, Rubino JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care

facilities. Am J Infect Control. 2000;28:3-7. Nagatake T, Ahmed K, Oishi K. Prevention of respiratory infections by povidone-iodine gargle. Dermatology 2002;204:32-36. Charles Vega, MD, FAAFP, Assistant Clinical Professor, Department of Family Medicine; Associate Residency Director, University of California - Irvine, Orange, California Disclosure: Charles P. Vega, MD, FAAFP has reported he received grants for educational activities from

Pfizer.

 

 

 

 

 

 

 

 

 

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