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Cold and Flu Support

Protocols Fullscript Protocols
Cold and Flu Support

Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

As a result, the Fullscript Integrative Medical Advisory team advises using an evidence-informed approach to protocol development. To simplify this process for practitioners, we have assembled a sampling of evidence-based standardized protocols that practitioners can use as a foundation when developing individualized protocols.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence. These are categorized as follows:

A       Systematic review or meta-analysis
B       Randomized Double-Blind Placebo-Controlled (RDBPC)       2+ studies and/or 1 study with 50 + subjects 

C       Randomized Double-Blind Placebo-Controlled (RDBPC)       1 study 

Please refer to the complete Rating Scale for further information.

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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Cold and Flu Support

Vitamin C

1 g, once per day in adults and minimum 200 mg, once per day in children as an ongoing maintenance dose1,2

3 to 4 g, once per day at the onset of the common cold symptoms for the cold’s duration in adults1,2 to 2 g, once per day may be provided to children during a cold1,2

  • Reduces the duration of the common cold by approximately a half-day, or by 8% in adults and by 14-18% in children1,2
  • Reduces time of confinement by approximately six hours and fever duration by approximately a half-day, relieves chest pain and chills by approximately eight hours1
  • Improves antimicrobial and natural killer (NK) cell activities, lymphocyte levels, chemotaxis, delayed T cell responses, sympathetic nervous response, and induces anti-reactive oxygen species activity1

For more information on the uses of Vitamin C in other conditions, please refer to the Vitamin C reference guide.

Search for Vitamin C in the Fullscript catalog.

Panax quinquefolius (American ginseng)

400mg, once per day, minimum 8-16 weeks in healthy adults as a preventative measure3,4,5

  • Reduces the duration of colds or acute respiratory infections by approximately 5-6 days3,5
  • Reduces the incidence of colds by 25%4, the incidence of influenza and respiratory syncytial virus 6, and the relative risk of respiratory symptoms by 48%5
  • Reduces total symptom severity score for sore throat, runny nose, sneezing, nasal congestion, malaise, fever, headache, hoarseness, earaches, and cough4
Search for American ginseng in the Fullscript catalog.

Echinacea purpurea

Prevention: 0.9 ml, three times per day (equivalent to 2400 mg of extract), minimum 4 months7 

Acute: Up to 4.5 ml liquid extract (equivalent to 4000 mg), once per day at the first stage of cold development7

  • Reduces the relative risk of cold development by 10-58%8,9
  • Reduces days with symptoms by 26% (1.4 days)7,10 and symptom scores by 23%11
  • 52% fewer patients requiring concomitant use of aspirin, paracetamol, or ibuprofen7
  • Reduces the incidence of cumulative viral infections by 26% and recurring infections by 59%, including influenza virus and parainfluenza virus7
  • Increases associated counts for white blood cells, monocytes, neutrophils, and natural killer cells, and suppresses superoxide production in the later-phase of the cold by neutrophils12
Search for Echinacea purpurea in the Fullscript catalog.

Zinc

75-100 mg of elemental zinc as zinc acetate or zinc gluconate lozenges, once per day, within 24 hours of the onset of common cold symptoms, minimum 1 to 2 weeks cold13,15,16,17,18

  • Reduces cold duration by 33%, or by approximately 1.65 to 3 days in healthy adults cold13,14,15,16,17,19
  • Zinc acetate equivalently reduces the duration by 40% and zinc gluconate reduces the duration by 28%13, while other sources indicate greater efficacy with zinc acetate in healthy adults14 
  • Reduces the incidence of cold symptoms after 5-7 days in healthy adults and children16,17
  • Reduces the duration of muscle soreness by 54%, cough by 46%, voice hoarseness by 43%, nasal congestion by 37%, nasal discharge by 34%, scratchy throat by 33%, sneezing by 22%, and sore throat by 18% in healthy adults18,19
  • Reduces the incidence of common cold development, absence from school, and antibiotic use in children16
  • Improves anti-inflammatory and antioxidant profile via reductions in plasma interleukin-1 receptor antagonist (IL-1ra), intercellular adhesion molecule-1 (ICAM-1), TNF-ɑ, MDA, HAE, and 8-oHdG, and increases in IL-2 mRNA in mononuclear cells in healthy adults19,20
Search for Zinc in the Fullscript catalog.

Probiotics

Probiotics may reduce the incidence of colds with minor effects on prevention, as well as improve influenza vaccination efficacy for A/H1N1, A/H3N2, and B strains, but is dependent on strain and population.21,22,23

Pediatric: 

Common Cold

  • 5 billion CFU of Lactobacillus acidophilus NCFM (ATCC 700396), twice per day, minimum 6 months24
    • Reduces the incidence of fever by 53%, cough by 41%, and antibiotic use by 68%
    • Reduces the duration of fever, coughing, and rhinorrhea by 32%
    • Reduces days absent from childcare by 32%

Influenza

  • 10 billion CFU of Bifidobacterium animalis subs. lactis Bi-07 (ATCC PTA-4802) & Lactobacillus acidophilus NCFM (ATCC 700396), twice per day for 6 months24
    • Reduces the incidence of fever by 73%, rhinorrhea by 73%, cough by 62%, and antibiotic use by 84%
    • Reduces the duration of fever, coughing, and rhinorrhea by 48%
    • Reduces days absent from childcare by 28%

Adult:

Common Cold

  • 1 billion CFU of Lactobacillus paracasei 8700:2 (DSM 13434) & Lactobacillus plantarum HEAL 9 (DSM 15312), once per day for 3 months25
    • Reduces the incidence of developing more than one common cold episode and number of days with a cold
    • Reduces total symptom scores & pharyngeal symptoms of cold
    • Reduces B lymphocyte proliferation

Influenza

  • 10 billion CFU of Lactobacillus fermentum CECT5716, once per day for 2 weeks before influenza vaccination and two weeks after26
    • Reduces the incidence of influenza 5-months after vaccination compared to vaccine alone
    • Increases natural killer cells, T-helper response, and IgA levels
  • 10 billion CFU of Lactobacillus rhamnosus GG, twice per day for 4 weeks after influenza vaccination27
    • Increases seroprotection for the H3N2 strain during the supplementation period
  • 500 mg of Saccharomyces cerevisiae (EpiCor®), once per day for 12 weeks28,29
    • Reduces the incidence of cold/flu symptoms with or without prior vaccination
    • Reduces the duration of symptoms with prior vaccination

For more detail on probiotics and their various uses in immune function, please refer to the probiotics immune support guide.

Search for Probiotics in the Fullscript catalog.

References

1
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/30069463
2
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/23440782
3
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/19592479
8
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/24554461
9
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/16678640
10
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/17597571
13
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/28515951
14
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/22566526
15
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/27378206
16
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/23775705
17
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/28480298
18
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/25888289
21
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/23372900
22
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/29416317
23
Systematic review or meta-analysis of human trials
a
https://www.ncbi.nlm.nih.gov/pubmed/29077061