What is the recommended treatment for the common cold in an emergency department?

From the Guidelines

The recommended treatment for the common cold in an emergency department is primarily supportive care, focusing on symptom management with over-the-counter medications and avoiding antibiotics due to their ineffectiveness against viral infections and potential for adverse effects. Treatment should prioritize alleviating symptoms such as fever, pain, nasal congestion, and throat discomfort. According to the european position paper on rhinosinusitis and nasal polyps 2020 1, there is no evidence of benefit from antibiotics for the common cold, and their use can cause significant adverse effects.

Symptom Management

• Fever and Pain: Can be managed with acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours.
• Nasal Congestion: Can be treated with pseudoephedrine (Sudafed) 60mg every 4-6 hours or phenylephrine 10mg every 4 hours.
• Runny Nose and Sneezing: Antihistamines like diphenhydramine (Benadryl) 25-50mg every 6 hours may provide relief.
• Throat Discomfort: Can be relieved with lozenges or warm salt water gargles.

Additional Considerations

• Adequate Hydration and Rest: Essential for recovery.
• Antibiotics: Not recommended for uncomplicated common colds due to their ineffectiveness against viral infections and the risk of adverse effects, as emphasized by the advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention 1.
• Emergency Department Visits: Typically only necessary for concerning symptoms such as high fever, severe shortness of breath, or signs of dehydration, which may indicate a complication or secondary infection requiring additional intervention.

Prevention and Alternative Therapies

• Vitamin C: May be useful for people exposed to brief periods of severe physical exercise, and its supplementation may reduce the duration and severity of colds, as suggested by the european position paper on rhinosinusitis and nasal polyps 2020 1.
• Zinc: Administered as zinc acetate or zinc gluconate lozenges at a dose of >=75 mg/day and taken within 24 hours of onset of symptoms, significantly reduces the duration of the common cold.
• Nasal Saline Irrigation: May provide benefits for relieving symptoms of acute upper respiratory tract infections.
• Echinacea Products and Other Herbal Medicines: Have not been shown to provide significant benefits for treating colds, although some products like BN1016, Cineole, and Andrographis paniculata SHA-10 extract may have a positive impact on symptoms without important adverse events.

From the Research

Treatment of the Common Cold in the Emergency Department

The common cold is a major and recurrent cause of morbidity, affecting children and adults two or more times each year 2. In the emergency department, the treatment of the common cold typically focuses on alleviating symptoms.

Recommended Treatments

• Over-the-counter analgesics, such as paracetamol or ibuprofen, can be effective in reducing fever and relieving headache and body aches 3, 4.
• Nasal decongestants, such as pseudoephedrine or oxymetazoline, can provide short-term relief of nasal congestion in adults 2, 5.
• Antihistamine-decongestant-analgesic combinations may have some general benefit in adults and older children, but the effect on individual symptoms is probably too small to be clinically relevant 6.
• Zinc and ipratropium may also be beneficial in alleviating cold symptoms in adults 3.
• In children, acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils may be effective in relieving cold symptoms 3.

Important Considerations

• Over-the-counter cold medications should not be used in children younger than four years 3.
• Patients should be informed about the self-limited nature of the common cold to manage expectations and limit antibiotic use 3.
• Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses 3.
• The effectiveness and safety of nasal decongestants in children are yet to be determined, and their use is not recommended in children younger than 12 years of age 2, 5.