the homeopathic treatment of upper respiratory infections

Retail Clinician CE Lesson• Acute bronchitis in otherwise healthyadults should not be treated with antibiotics;delayed prescriptions may helpease patient fears and simultaneouslyreduce inappropriate use of antibiotics. 6Complementary and alternative medicineWithout the immediate use of antibioticsand with restrictions on the use of over-thecountermedications for upper respiratory infections,many advance practice clinicians maylook to complementary and alternative medicine,or CAM, approaches to the treatment ofthis common presentation. Likewise, a 2007CDC National Health Statistics showed that38% of adults and 12% of children employedsome types of CAM. 7CAM is considered those diverse medicaland healthcare approaches, practices and productsthat are not typically thought of as part ofconventional medicine. Upper respiratory infectionsare high on the charts of illnesses forwhich patients sought CAM approaches: eighthamong adults and third among children. 8For upper respiratory infections, some ofthe common CAM treatments are diet andnutritional supplementation, botanical medicineand hydrotherapy. Dietary recommendationsoften will include removing dairy fromthe diet. For some patients, dairy increases theproduction of mucus, and removing it will inturn decrease the mucus load. Chicken soup asa healing food has been used for centuries andhas enjoyed some recent scientific support asone part of treatment for URI. 9 Miso broth alsocan be suggested as a way to break up congestionand sooth irritated mucus membranes.Botanical medicine has been used for generationsin the form of teas, poultices, powdersand tinctures. In recent times, such herbsas garlic, Echinacea and Astragalus have beentouted for their antiviral effects.Hydrotherapy in the form of a cool mist vaporizer,or the use of a hot footbath, also hasbeen suggested. When using a vaporizer, it isrecommended to use distilled water, which willminimize the contaminants being sent into theair and also will aid in keeping the unit clean.HomeopathyHomeopathy is a distinct system of CAMmedicine. It has been used around the worldfor the past 200 years and offers a safe and effectiveapproach to healing. Patient symptomsare understood according to the classic physiologicmodel taught to all healthcare providers.As the patient strains against both internaland external stressors, such as viruses, thepatient develops symptoms; the symptoms areseen as the person’s way of addressing this dynamic.10 It is the gleaning and understandingof the details of and connections among thesesymptoms that lead the prescriber to a particularhomeopathic remedy.Used the world over for the treatment offirst aid, acute and chronic conditions, homeopathyhas a long history of application in thetreatment of URI and will be described herefirst in its general philosophy and terms, andthen as it applies to URIs.Homeopathic medicines have been classifiedas drugs within the meaning of the federalFood, Drug and Cosmetic Act since 1938. 11 Officialhomeopathic drugs are those that havemonographs in the Homeopathic Pharmacopoeiaof the United States, or HPUS. TheHPUS is prepared by a nongovernmental organization,the Homeopathic PharmacopoeiaConvention of the United States, which is composedof scientists and clinicians trained in themedical specialty of homeopathic medicine. 12Homeopathic remedies are available overthe-counterin many pharmacies, grocerystores and health food stores. The remedies arehighly diluted substances from plant, mineraland animal sources. They are cost effective anddo not carry weighty side effect profiles. Mosthomeopathic remedies are prepared on smalllactose pills and taste sweet. Remedies are safeto use with other medications and do not interactwith over-the-counter drugs, prescriptiondrugs or with other natural medicines,such as nutritional supplements or botanicalmedicines. Homeopathic remedies differ fromother CAM approaches in that the remediesare strongly diluted and are prescribed in aunique and distinctive fashion.History of homeopathyHomeopathy was first conceived by SamuelHahnemann (1755-1843), a German physicianand chemist. Troubled by the harshnessof medical protocols of his time, as well as bypersonal family tragedies, he turned awayfrom medical practice and devoted himself tothe work of scientific translation. It was duringhis work on a translation of a then popularbook on botanical medicine, “Cullen’s MateriaMedica,” from the English into German that hebecame intrigued with the portion written onCinchona bark — from which quinine eventuallywas derived — and the close relationshipbetween its effectiveness and its toxicity. Hiscuriosity was ignited.He undertook what essentially was thefirst drug trial, known as a proving, givinghealthy subjects samples of the substance inquestion and seeing what, if any, effect it hadupon them. 13 To his surprise, in the case of theCinchona bark, a number of participants developedthe very symptoms that the herbalpreparation was known to help.From this observation was born similiasimilibus curantur from the Latin, “likes arecured by likes.” This essential underpinningof homeopathic practice can be further definedas follows: any drug that is capable ofproducing morbid symptoms in the healthywill remove similar symptoms occurring asan expression of disease. 14In his lifetime, Hahnemann conductedprovings on some 106 substances. He workeddiligently and wrote prolifically on topicsof homeopathic philosophy, the treatmentof chronic disease and the “Materia MedicaPura,” one of the earliest homeopathic drugcompendiums written. 14Hahnemann also set out to determine whatthe optimal dosage of medication would be toachieve both best clinical outcomes and theleast side effects. His ideas about using theminimal dose whenever possible have stoodthe test of time. His experimentations led toconcepts of dilution and succussion, which areused in the manufacturing process of homeopathicremedies. 14Homeopathy in practiceHomeopathy is used to treat first-aid problemsas well as acute and chronic diseases.First-aid problems are addressed in rathercookbook fashion. For example, many haveheard of using the homeopathic remedy Arnicafor the treatment of trauma. Because traumaticevents impact most people in a similar fashion,Arnica is one of only a handful of remedies tobe considered. In other words, when the stressfrom the outside is very severe, most individualsrespond in a similar fashion. That responsewill point to one of only a few remedies.For acute, self-limited problems, such as upperrespiratory infections, patients present in a3 • Winter 2011 RetailClinician.com Retail Clinician

Retail Clinician CE Lessonmore individualized manner. For instance, oneperson with a URI might have copious nasaldischarge along with a headache and loosestools, while another might feel dried out inthe sinus area and present with a tickle in thethroat, while simultaneously having torticollis.Though both have a URI, they would requireand respond to two different homeopathicremedies. The homeopath is addressing thewhole person at any one time. With most acuteillnesses, there are a limited number of remediesto choose from because there are only somany ways an acute problem can manifest.When patients present in the office withwhat appears to be an acute problem, the advancepractice clinician should be interested inunderstanding if it is truly an acute problem orif it is rather a flare-up of an underlying chroniccondition. This would be true in illnesses forwhich flare-ups are common, such as multiplesclerosis, migraine headache and asthma, butalso can be found in those with upper respiratoryinfections. Differentiating at this junctureinforms treatment options and impacts boththe homeopathic remedy choice and dosage.Single homeopathic remedies are given basedon the presenting symptoms of the patient.Homeopathic remedies are given for individualpeople, as opposed to specific diagnoses.One could have five patients with upperrespiratory infections, and they might receivefive different remedies depending on howthey experience the problem (i.e., how it actuallyfeels; what the symptoms are; what typeand amount of mucus; the type of pain or discomfort;what makes the symptoms or the patientfeel better, if anything; what makes himor her feel worse; was there a clear initial etiology;did anything bring on the episode; anddoes the patient have any other symptoms simultaneously).The homeopath is interested inhow the upper respiratory infection fits in tothe rest of the person’s physical health. In addition,it is central to perceive how those physicalcharacteristics sit vis-á-vis the patient’stemperament and mood.All symptoms are context dependent. Onecannot see a symptom standing by itself;rather, the homeopath has to understand eachsymptom a patient reports as it relates to thewhole person. The typical intake for a homeopathicphysician for a chronic condition is 60to 90 minutes, allowing enough time to fullyunderstand the patient and all aspects of hisor her lifestyle and health. For acute problemslike upper respiratory infections, a 10- to15-minute office visit suffices.Homeopathy in the literatureThere have been numerous studies on homeopathythat have appeared in the orthodoxmedical literature. Notably, the Lancet publisheda review article in 1997 that was a meta-analysisof 89 blinded, randomized, placebo-controlledclinical trials. 15 The trials looked at homeopathictreatment of such complaints as hay fever,asthma, rheumatoid arthritis, diarrhea, influenza,varicose veins, strains and sprains, and postsurgicalcomplications. Patients who receivedhomeopathic medications were 2.45 times morelikely to receive a positive response than thosegiven placebo, which should encourage furtherand more widespread clinical and laboratorystudy of the efficacy and mechanism of actionof homeopathic remedies. 15Single homeopathic remediesTen of the most common homeopathic remediesfor upper respiratory tract infection areAconite, Belladonna, Gelsemium, Pulsatilla,Patient Scenario 1Chamomilla, Bryonia, Phosphorus, Mercurysolubilus, Rhus toxicodendron and Arsenicumalbum. There are other single homeopathicremedies that are indicated for the treatmentof upper respiratory tract infections, but these10 will go a long way to helping those withsuch viral infections.The typical dose for single homeopathic remediesis a 30c potency given three times a day. Ifit does not seem to be helping after 24 hours, itis likely not the correct remedy. Patients shouldbe sent home with both the first and secondchoice remedy, with direction to use the secondremedy if after 24 hours the symptoms havepersisted with no change. Once the patient isfeeling better, the remedy should be discontinued.Keeping up other supportive therapy isrecommended, but no further treatment withthe initial homeopathic remedy would be indicated.Some patients move from needing oneremedy to another over the natural history ofan illness. If symptoms return after a few days,manifesting in the same way as they had been,the previous remedy can be given. If a newsymptom picture has been drawn, a new remedywill need to be chosen.A long-term patient, Marjorie, presented to the clinic with the chief complaint of a cold and fever. This 54-yearoldnurse had enjoyed good health throughout her life and was taking no medication. She described the onsetof illness as very fast over the past 24 hours with a runny nose and feeling warm. She described a sensationof feeling full in the head and a runny nose, yet her nose felt very dry at the same time. She reported dry eyesand dryness in her mouth and lips. She complained of vertigo, which was worse when she moved her head orleaned forward. She was concerned about an ongoing queasiness, which was better if she ate or if she had acold drink. Her fatigue was quite strong as was her irritability. She was snapping at her husband and teenagechildren for small matters and generally felt annoyed by those around her.A brief review of systems was unremarkable, with the exception of a week or so of constipation, uncommonfor her. Additionally, she said her skin felt dry in general and the skin of her heels was cracking.On physical exam, erythema was noted rimming the eyes and there was swelling bilaterally in the nasal passages.Her lips were cracked and peeling, and she had slightly enlarged anterior cervical glands, which weremildly tender to touch. Temperature: 101.4 degrees.This patient preferred to use natural medicine and asked for homeopathy in particular. She did not feel like it wouldbe easy to swallow supplements too easily. She also felt like herbal preparations might contribute to her queasiness.DiscussionWhen a patient presents whose chief complaint is general in nature (runny nose, fever) and the advancedpractice clinician is seeking an accurate, single-dose homeopathic remedy, look to concomitant symptomsand physical or emotional general symptoms to point the way to an accurate remedy. In Marjorie’s case, thevertigo, which was marked, was a clear concomitant manifestation of the virus causing her acute illness.That, coupled with the dryness — a general symptom that Marjorie experienced throughout her system,from her eyes to her lips to her heels — and the constipation, also became important elements. Her overallirritability and short temper were a further, albeit psychological, manifestation of a general symptom.The single homeopathic remedy, Bryonia alba is indicated for URI, especially when there is dryness, irritabilityand vertigo. Marjorie took Bryonia alba 30c, with directions to call the next day. She reported that by the time shegot home the vertigo had abated. She slept well and long, and woke up feeling back to herself. Over the course ofthe following week, she took one more dose of Bryonia 30c when she felt a tinge of the vertigo return.Retail Clinician RetailClinician.com Winter 2011 • 4

Retail Clinician CE LessonFor each remedy, read below for a descriptionof the symptoms a person who needs thatremedy will have, and also the more temperamentalaspects you might expect to find. Interms of doing an intake with an eye to prescribinga homeopathic remedy, it also willbe important to ascertain the general physicalsymptoms a patient has, such as any sense ofbeing warm or chilly and his or her level ofhunger, thirst and perspiration. It also can beimportant to ascertain how the illness began.Did it come on quickly in a few hours, or wasit over several days that the patient startedto feel ill? A quick review of systems also canhelp when taking a homeopathic case; oftentimesit is the symptom, such as constipationor itchy skin, a bit distant from the upper respiratorytract that will help guide or confirma homeopathic remedy prescription.Patient Scenario 2AconiteThe remedy Aconite is derived from the plantAconitum napelles and is prescribed whenthere has been a sudden onset of sniffles andrunny nose. Oftentimes the patient has beenexposed to a cold wind and caught a chill. Thepatient may complain of a dry throat, with attendantdry cough. There may be ear pain andlow-grade fever. If Aconite is given at the firstsign of inflammation, it may well cut the upperrespiratory tract infection short. The patient willreport thirst for cold drinks and may feel warmwith intermittent chilliness. You may observe aflushed face or perhaps only one cheek flushed.The patient also may describe tingling or burningfeelings in the face or extremities. Headachemay accompany the early signs of upper respiratoryinfection, as well as irritated and injectedeyes. Aconite often is used in the first 24 to 48hours after onset of symptoms, and rarely isused when an upper respiratory tract infectionis in full swing. If the patient’s symptoms cameon suddenly and are accompanied by anxietyor worry, with any sort of tingling sensationand low tolerance to pain, Aconite may well bethe homeopathic remedy to suggest.BelladonnaBelladonna is one of the most commonlyprescribed homeopathic remedies also utilizedfor the very beginning of inflammation. Oftenthe homeopath sees that there is a general illness,but the inflammation has not yet settledin the sinuses or the ear. There is a flushed face,a high fever or a patient with a warm or hothead, though the extremities feel cold. Patientswith upper respiratory infections with fever, especiallyif there is a feeling of congestion, andthrobbing pain either in the form of headacheor sore throat, should be given Belladonna. Ingeneral, the patient will appear flushed, and infact there may be high fever with perspiration.Patients may feel light-headed, and there maybe redness to the ears, nose or lips, with bright,shiny eyes. Sensitivity to light, sound and smellalso are marked in patients needing this remedy.This sensitivity crosses over into the emotionalrealm, with the patient being sensitiveand irritable. He or she will be aggravated bybright lights, loud noises or people, or by beingWhen 21-year-old Robbie came to the clinic, he looked like he was under water. He had a dull look to his usuallybright eyes, spoke with a mucous-filled, nasal tone and was finding it hard to keep his head up. He blewhis nose continuously, with a pale yellow discharge freely flowing. He had a loose cough, which brought upphlegm. He described getting sick over the long weekend, just not feeling well and maybe having a low-gradefever. He was not too interested in food and just about thirstless. He’d make himself drink because he knewhe should, but he was not thirsty.This usually independent, robust young man while sick preferred to be in the same room with his mom or dad,didn’t want to talk too much, but also did not want to be left alone. He spent the past several days lying on thecouch, keeping cozy and watching reruns of favorite TV shows.DiscussionIn a case like this where there is copious mild discharge, in a warm and thirstless person, the homeopathicremedy prescribed is Pulsatilla. Those needing Pulsatilla tend to be a bit clingy and emotional, feeling theyneed to lean on someone and be taken care of. Sometimes the etiology is strictly exposure to the germ;sometimes it is preceded by some kind of emotional upset, where the patient feels abandoned or forsaken.After taking Pulsatilla 30c two times that day and once the next, Robbie reported feeling clearer-headed,having less mucous in the nose and down the throat, and a return to his usual energetic self. His thirst cameback, and within a few days of the remedy, he was symptom-free.jarred or bothered. There is a general restlessnessin people who need Belladonna, and patientswho respond well to this remedy moreoften have complaints that are on the right side,such as right-sided sore throat.GelsemiumFor those who need Gelsemium, the homeopathwill see, and the patient will report, deepfatigue, a kind of weariness where they can barelykeep their eyes open. People who need thisremedy will complain of chills running up anddown the spine, they will have excess salivationand feel damp and sweaty. There will be a weaknessand perhaps slight sense of being either outof this world or a bit tremulous. The words dull,droopy and drowsy come to mind when we describethe patient that needs Gelsemium.PulsatillaPulsatilla should be given to the patientwho has copious yellow-green discharge fromthe nose; the discharge is characteristicallybland and does not irritate the nose or the areabetween the nose and mouth. The dischargesalso may impact the eyes, where the patientwakes up with the eyes agglutinated. The patientwill be warm and thirstless, and feel betteroutside or in open air. There is a general feelingof being forsaken and needing emotionaland physical support. The idea of being clingy,needy and easily consoled will help confirmthe need for this remedy. Children want to beheld, adults want the back to be rubbed, etc. Itis important to remember that a nursing childwho needs this remedy might want to be at thebreast, but it is more for comfort than for feeding.When presenting with a URI, the patientneeding Pulsatilla will be easily overwhelmedand commonly moved to tears.ChamomillaFor patients who need this remedy, the irritabilitywill be the most marked symptom.This remedy is thought of when the respiratoryinfection seems to come along each timethe child is teething. Parents of patients reportthis symptom commonly, and Chamomillacan help a family get through this time. Therewill be general congestion and in some a drynighttime cough. There usually is an attendantloose stool with the upper respiratory tract infectionalongside a grumpy, difficult to pleasebaby, toddler or child.5 • Winter 2011 RetailClinician.com Retail Clinician

Retail Clinician CE LessonBryoniaThe patient needing Bryonia tends to bedry in all ways: dry eyes, dry nose, dry mouthand constipation. The dry cough can lead to aheadache. The patient may feel sick, perhapscomplaining of vertigo, nausea or both. Theupper respiratory tract infection is accompaniedby a hard, barking cough accompaniedby thirst for cold drinks. Patients generallyfeel quite irritable and want to be leftby themselves. They are aggravated in theirsymptoms by any motion, so they prefer tokeep very still and to be left alone.PhosphorusThe patient needing Phosphorus will besimilar to Pulsatilla, in that he or she willcrave and feel better with attention, but he orshe is chillier and desires iced cold drinks. Itis common to have a hard cough that is worsefrom talking or laughing. If the cold is producingmuch nasal discharge, it may be tingedwith blood. Those who need this remedy oftenhave looser stools.Merc solWith the remedy Merc sol, the patient willhave excessive sneezing and attendant mucus.The discharges tend to be acrid and causethe nostrils to become chapped and raw. Patientswho need this remedy during an upperrespiratory infection tend to have excessivedischarges of both mucus and saliva. Therealso can be an acrid copious discharge fromthe eyes, which irritates the conjunctiva. Theconcomitant cough may produce thick, yellowsputum. Patients who need Merc sol tend tofeel chilly and want to be well covered. Therelikely will be a fever, especially at night withperspiration. Concomitant symptoms may includethirst for cold water and a thick, moisttongue, which has taken the imprint of theteeth on its edges. Patients who need Merc solare usually worse at night and worse in dampand cold weather.Rhus toxicodendronThe main symptom you will see in patientswho need Rhus toxicodendron is restlessnesswith all of their complaints. There may be ulcerationat the tip of the nose or the tip of thetongue. A sore throat with the upper respiratorytract infection, with swollen glands, is acommon finding. Dry cough and restlessnessin children or adults, where the patient feelsbetter if he or she can move around, also maybe present. There may well be a concomitantdesire for cold milk. The patient mayfeel better when kept warm with blankets orwrapping up.Arsenicum albumPatients needing Arsenicum album are almostalways very chilly; they feel better indoorsand away from any chill. There will bea thin and watery, irritating discharge fromthe nose, even while the nose feels stoppedup. Many of the complaints a person needingArsenicum album presents with have a burningaspect. So the discharges from the noseburn that area, the eyes feel burning and themucus going down the back of the throat isburning. It may be difficult to swallow dueto a burning sore throat. Those needing thisremedy are worse as the night goes along, oftenat their very worst in the middle of thenight. The tongue will appear clean and redwithout excess salivation. Though the patientwill be extremely tired, he or she willhave noticeable restlessness and will be quiteanxious. This can be in an otherwise anxiousperson, but also in someone who generally iscalm. If they develop an acute illness, such asan upper respiratory tract infection, which indicatesthe need for Arsenicum album, theymay develop short-term anxiety. To the advancepractice clinician, the extreme fatiguemay seem out of proportion to the actualpathology perceived. These patients desirewarm drinks and are ameliorated by anythingthat helps them to warm up.Combination homeopathic remediesThere also are combination homeopathicremedies available, which are prescribedbased more on the diagnosis than the individual.These combination remedies contain severalof the most common remedies for treatmentof people with the condition in questionand can be thought of in the treatment of upperrespiratory infections. These remedies arenot applied in accordance with homeopathicphilosophy (i.e., these combinations are notrecommended based on the whole personand have not undergone a separate homeopathicproving, but rather go by the provingsof the respective single entity components);however, many patients have found help usingthem for the targeted treatment of trulyacute disease.Selecting single-ingredient remedies requiresspecialized knowledge of homeopathicpreparations, as well as time from the care provider.In a retail clinic setting, it may be morefeasible to recommend a combination product.See Table 3 for common combination homeopathicremedies. Of note, some manufacturersof combination homeopathic products add botanicalor food supplement ingredients to theproducts, such as honey.Most homeopathic remedies are applied tosmall lactose pellets. They are taken by placingthem under the tongue or in the mouth and allowingthem to dissolve, away from food anddrink. It is safe to give these small pellets toinfants and those with difficulty swallowing.For combination homeopathic remedies, referto product-specific labeling for dosing instructionsand age limitations, if applicable.ConclusionUpper respiratory tract infections remainamong the most typical reasons patients visithealthcare providers. Increasingly, patientsseek CAM approaches to help with commonailments. Homeopathy can be offered as a safeand effective alternative to help patients recovermore quickly from URI.Homeopathy ResourcesBelow are several resources that provide additional information regarding homeopathy:• The National Center for Homeopathy:NationalCenterForHomeopathy.org• The American Association of Naturopathic Physicians:Naturopathic.org• The North American Society of HomeopathsHomeopathy.org• “The Complete Homeopathy Handbook” by Miranda Castro7 • Winter 2011 RetailClinician.com Retail Clinician

Retail Clinician CE Lesson1 Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 Summary. Hyattsville, MD: National Center for Health Statistics; 2008. National Health StatisticsReports. 2 Meneghetti A. Upper Respiratory Infection. MedScape Reference Web site. Available at: http://emedicine.medscape.com/article/302460-overview#a0199. Accessed Oct. 2, 2011.3 Cold and Cough Medicine: Information for Parents. Centers for Disease Control and Prevention Web site. Available at: http://www.cdc.gov/features/pediatriccoldmeds/. Accessed Oct. 2, 2011.4 Meneghetti A. Upper Respiratory Infection Differential Diagnoses. MedScape Reference Web site. Available at: http://emedicine.medscape.com/article/302460-differential Accessed Oct. 2, 20115 Rabkin M. Chapter 17: Upper Respiratory Infection. Available at: http://www.medicineclinic.org/AmbulatorySyllabus4/NEW%20UPPER RESPIRATORY INFECTION.htm. Accessed Oct. 4, 2011. 6Wong, DM, Bumberg, DA, Lowe, LG. Guidelines for the Use of Antibiotics in Acute Upper Respiratory Tract Infections. Am Fam Physician. 2006 Sep 15;74(6):956 7 National Institutes of Health. NationalCenter for Complementary and Alternative Medicine. The Use of Complementary and Alternative Medicine in the US. Available at: http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm. Accessed Oct. 4, 2011. 8 National Institutes of Health. National Center for Complementary and Alternative Medicine. Colds and Flu and CAM: At a Glance. Available at: http://nccam.nih.gov/health/flu/ataglance.htm. Accessed Oct. 4, 2011. 9 Rennard, B., Ertl, RF., Gossman, G, Robbins, RA and Rennard, SI .Chicken Soup Inhibits Neutrophil Chemotaxis In Vitro. Chest 2000;118;1150-1157. 10 Herscu, P. Stramonium, with an Introduction to Analysis Using Cycles and Segments. Amherst, Massachusetts. New England School of Homeopathy Press. 1996. 11 Food, Drug, andCosmetic Act of 1938, Pub. L. 103-417, 52 Sta. 1041 (1938). 21 U.S.C. §321(g)(1) (1938). 12 Homeopathic Pharmacopoeia Convention of the United States. Overview. Available at: www.hpus.com/overview.php. Accessed Oct. 11, 2011. 13 Herscu, P. Provings, with a Proving of Alcoholus. Amherst, Massachusetts. New England School of Homeopathy Press. 2002. 14 Hahnemann, S.(1996) The Organon of the Medical Art O’Reilly, WB, (Ed.). Palo Alto, California. Birdcage Books. 1996. 15 Linde,K , et. al. Are the Clinical Effect of Homeopathy Placebo Effects? A Meta-Analysisof Placebo-Controlled Trials. The Lancet, 1997 Sep 20;350(9081):834-43. 16 Products Coldcalm. Boiron USA Web site. Available at: www.boironusa.com/products/coldcalm.php. Accessed Oct.6, 2011. 17 Hyland’s Homeopathic Medicines. Hyland’s Web Site. Available at: http://www.hylands.com/products/productmain2.php. Accessed Oct. 6, 2011. 18 Zicam Products. Zicam Web Site.Available at: www.zicam.com/products/coldremedy_rapidmelts. Accessed Oct. 6, 2011.Learning AssessmentSuccessful completion of “The homeopathictreatment of upper respiratory infections” isaccredited for 1 hour of continuing educationcredit, of which 0.5 hours are considered pharmacologycredit. To obtain credit, answer thefollowing questions and complete the evaluationonline at RetailClinician.com.1. Which of the following should be consideredin a differential diagnosis for upperrespiratory infection?a. Herpes simplexb. Otitis mediac. Pneumoniad. A & Ce. All of the above2. The most common finding upon aphysical exam of a patient with anupper respiratory infection will be_________________.a. Feverb. Tachycardiac. Inflammation of the respiratory mucosad. Occlusion of the paranasal sinuses3. Which of the following are true regardingsmoking and upper respiratory infection?a. Smoking cessation will reduce both theincidence and the intensity of illness.b. Patients or caregivers should be counseledto minimize the exposure thatchildren or other sick people have tosecondhand smoke in the home.c. Incidence of URI for those exposed tosecondhand smoke is decreased.d. A & Be. All of the above4. The American Family Physician Guidelinesfor the Use of Antibiotics in AcuteUpper Respiratory recommend which ofthe following?a. In patients with sinus infection, acute bacterialrhinosinusitis should be diagnosedand treated with antibiotics immediately.b. In patients with sore throat, a diagnosisof group A beta-hemolytic streptococcuspharyngitis generally does not requireconfirmation with rapid antigen testing.c. Acute bronchitis in otherwise healthyadults should be treated with antibiotics.d. A period of observation without immediateuse of antibiotics is an option forcertain children.5. Homeopathic remedies are prepared inaccordance with the U.S. HomeopathicPharmacopoeia, which advises and setsstandards and reports to the Food andDrug Administration.a. Trueb. False6. Which of the following principlesdoes not apply to homeopathy?a. “Like cures like”b. Clinician should use the maximum dosepossible that doesn’t cause side effectsc. Any drug that is capable of producingmorbid symptoms in the healthy willremove similar symptoms occurringas an expression of diseased. Clinicians should use theminimal dose possible7. Which of the following are homeopathicremedies that may be used to treat upperrespiratory infection?a. Belladonnab. Aconitec. Pulsatillad. A & Ce. All of the above8. _______________ may be an appropriatesingle homeopathic remedy for a patientwho presents with deep fatigue, also complainingof chills running up and downhis spine, and feels damp and sweaty.a. Gelsemiumb. Pulsatillac. Rhus toxicodendrond. None of the above9. Combination homeopathic remedies areprescribed based more on the diagnosisthan the individual and can be useful in thetreatment of upper respiratory infection.a. Trueb. False10. Which of the following should be includedin patient or caregiver counselingfor upper respiratory infection?a. The importance of hand washingb. Adequate hydrationc. Getting sufficient sleepd. All of the aboveRetail Clinician RetailClinician.com Winter 2011 • 8