First-generation oral antihistamines, such as chlorpheniramine and clemastine, reduce sneezing and, to a lesser extent, rhinorrhea, probably because of their anticholinergic effects, but are often associated with excess sedation. Nonsedating antihistamines such as terfenadine and astemizole are not effective for colds in nonallergic persons. Cough suppressants with codeine or dextromethorphan may be used if the cough is severe or disturbs sleep. Cough suppressants should be used cautiously in patients with underlying chronic obstructive pulmonary disease. Pharyngitis is often a prominent complaint of persons with adenovirus and influenza virus infections.
Enteroviruses are also important causes of fever and pharyngitis during summer and early fall.
Some infections are associated with characteristic enanthema, such as palate vesicles and ulcers caused by coxsackievirus-induced herpangina, acute ulcerative stomatitis or pharyngitis caused by HSV, or exudative pharyngitis related to EBV mononucleosis. Pharyngitis occurs with primary HIV infection. Without coryza, pharyngitis caused by group A and other streptococci, Chlamydia , or Mycoplasma is more likely to occur, and appropriate microbiological studies are needed for differentiation. In most cases of viral pharyngitis, treatment is symptomatic, although HSV stomatitis responds to acyclovir. Hoarseness caused by laryngitis frequently occurs during acute viral infections and is more common during infections caused by viruses that invade the lower airways.