Question: Hello Doctor. My son, 2.5 years old, he gets a cold quiet often. when we go to doctors here, they usually diagnose a bad throat and prescribe him ponstan syrup and combine with panadol if fever is getting out of control. they also prescribe to nebulize with normal saline solution and zertec anti allergy syrup but half a doze 2.5ml instead of the regular doze 5ml. some other symptoms are runny nose to start off with, which over the course of days becomes a stuffy nose and we feel his sinuses are blocked. we can hear phlegm in a chesty cough but he is unable to cough it up. variable fever going up as high as 103 sometimes.

i had a few questions. why do the doctors here prescribe ponstan instead of regular panadol. i have heard and read than ponstan is not recommended for children and 2. why do they prescribe half a doze of zertec instead of the regular full doze? 3. How are otrivin child nasal drops for relieving the above symptoms and which symptoms exactly do they target, runny nose or stuffy nose, or does it help in the release of phlegm? 4. what symptoms does calpol nasal spray treat? doctors here prescribe to nebulize with normal saline. does this relieve the phlegm. what is the affect of hot steaming for the relief of symptoms as compared to nebulizing with normal saline?

Dr. XXXXXXX Bhagat,

Thank you for your reply.

1. You mentioned that ponstan is an anti inflammatory medicine which can be used for relief of pain and fever. My son's pediatrician recommends ponstan because he says it relieves the bad throat as well. Is this correct? if it has nothing to do with the throat then regular panadol will have the same pain and fever relieving properties right? You also mentioned that ponstan works well with acetaminophen. what medicines is this drug found in?

2. The bottle of zyrtec (cetrizine hydrochloride) syrup that we have mentions the doze of children from 2-12 years of age as 5ml. Our doctor also says that the correct dozage is 5ml but he recommends 2.5ml because 5ml may lead to congestion and blockage of phlegm inside. I would appreciate if you could elaborate a little more on this.

Zyrtec-D is a different medicine which inlcudes a decongestant, pseudophedrine hydrchloride as well and is not given to children under 6 years of age. is this correct?

3. otrivin nasal drops. understood. today is the third day of the otrivin drops, we will stop these tomorrow. however our son's symptoms rotate between runny and blocked nose. can the drops be given in both cases of runny and blocked nose?

4. calpol nasal spray. understood.

5. nebulisation with normal saline and steaming with hot water. understood. this does help the congestion.

finally, we would like your personal prescription on the following symptoms. it starts with a runny nose and we feel there is also some congestion. as there are nasal sounds and he seems uncomfortable. fever comes and goes. sometimes it goes high with 102 103. I would like to ask, what can we start off with before even going to the doctor. can panadol and anti allergy be started right away without prescription. what about otrivin and calpol spray and nebulisation and steaming. in what cases should we start the antio biotic. he has been prescribed with azomax before, which they say is good for upper respiratory infections. the doctors here do not rush to prescribe anti biotic and only when the other medicines fail to control the fever, do they give it as a last resort. and they have never done a test before prescribing.

but my wife was in saudi arabia visiting her parents a few months ago and took our son to a doctor there and he said a few things which were on the contrary to the doctor's treatment here in pakistan. the doctor there asked if he was allergic to anything. we do not know for sure but considering that both me and my wife are, the doctor assumed that he probably got some allergies from us. he said that in his opinion, ponstan will aggravate his allergies and flare up his symptoms. he was the one who suggested we should start with zyrtec. he also did a throat swab test, the result came immediately, there was an infection and he prescribed azomax to treat it.

would appreciate some comments on the above.

Thank you and Best Regards,
XXXXXXX

Dr. Synthyia Bhagat,

Thank you for your reply and suggestions.

However some of my questions remain un answered.

1. You mentioned that ponstan is an anti inflammatory medicine which can be used for relief of pain and fever. My son's pediatrician recommends ponstan because he says it relieves the bad throat as well. Is this correct? if it has nothing to do with the throat then regular panadol will have the same pain and fever relieving properties right?

2. The bottle of zyrtec (cetrizine hydrochloride) syrup that we have mentions the doze of children from 2-12 years of age as 5ml. Our doctor also says that the correct dozage is 5ml but he recommends 2.5ml because 5ml may lead to congestion and blockage of phlegm inside. I would appreciate if you could elaborate a little more on this.

Zyrtec-D is a different medicine which inlcudes a decongestant, pseudophedrine hydrchloride as well and is not given to children under 6 years of age. is this correct?

3. our son's symptoms rotate between runny and blocked nose. can the drops be given in both cases of runny and blocked nose?

the doctor in saudi arabia said that in his opinion, ponstan will aggravate his allergies and flare up his symptoms. what is your opinion on this.

and one last thing i forgot to mention is that sometimes when the runny nose stops, he starts getting a post nasal drip. it irritates his throat and he is unable to cough it up and spit it out. we feel this is more serious than a runny nose because the phlegm is going back inside the throat and depositing in his chest. What is the best way to treat the post nasal drip, to either get it out through the nose or loosen up the mucus so it doesn's deposit and harden inside the chest.

i was promised 100% satisfaction to all my answers. so far i am 75% satisfied and the above questions still remain unanswered. you have been been very helpful so far, and i thank you for it, but i hope you understand that we are first time parents and have thousands of questions and these symptoms worry us when we do not know what to do. to make things worse, the doctor's diagnosis and prescription here in pakistan is a little hit and miss sometimes, the opinions are so varied, and that doesn't make matters any easier for parents.

this is the reason i have sought help from this site. this is also the first time i am using such a medium and so far your prognosis has made a lot of sense. i just have one more follow up left after this and would really appreciate complete responses to the above questions.

Thank you and Best Regards,
XXXXXXX

Dr Synthyia Bhagat,

Thank you for your responses. I am satisfied with your answers now and really appreciate them.

Just had a few closing questions to wrap up after which i shall close the discussion and rate your answers.

you mentioned that otrivin drops should not be given for more than 4 5 days. we have stopped these drops now but are continuing with the calpol nasal spray and zyrtec syrup. today is the 5th day i think. how long can we safely continue calpol nasal spray, zyrtec and nebulizing with normal saline without any adverse side affects?

anything we can do to treat the symptoms of post nasal drip? does nebulizing and steaming help this particular symptom?

Thank you and Best Regards,
XXXXXXX