Recommended Treatments for the Common Cold
The most effective treatments for common cold include combination antihistamine-analgesic-decongestant products, zinc lozenges (≥75 mg/day) taken within 24 hours of symptom onset, nasal decongestants, and symptomatic treatments like NSAIDs and acetaminophen, while antibiotics should not be prescribed as they provide no benefit and can cause significant adverse effects. 1, 2
First-Line Symptomatic Treatments
Decongestants
- Oral/nasal decongestants have a small positive effect on nasal congestion in adults 1
- Pseudoephedrine is FDA-approved for temporary relief of nasal congestion due to the common cold 3
- Should be used short-term only (≤3 days) to avoid rebound congestion 1
Pain and Fever Management
- NSAIDs provide significant benefits for headache, ear pain, muscle/joint pain, and show borderline benefit for malaise 1
- Acetaminophen helps relieve nasal obstruction and rhinorrhea but doesn't improve other symptoms like sore throat or cough 4, 5
Other Effective Treatments
- Zinc lozenges (zinc acetate or gluconate) at ≥75 mg/day started within 24 hours of symptom onset significantly reduces cold duration 1, 2
- Ipratropium bromide (intranasal) effectively reduces rhinorrhea but has no effect on nasal congestion 1
- Nasal saline irrigation may provide symptom relief, especially in children 1, 2
- Combination antihistamine-analgesic-decongestant products provide significant symptom relief in approximately 25% of patients 2
Second-Line and Adjunctive Treatments
Antihistamines
- Provide limited short-term benefit (days 1-2) for overall symptom severity in adults 1
- No significant effect on nasal obstruction, rhinorrhea, or sneezing 1
- Consider as part of combination therapy rather than monotherapy 2
Vitamin C
- May be worth trying on an individual basis 1
- Modest reduction in cold symptom duration when used prophylactically 6
Treatments to Avoid
Antibiotics
- Do not prescribe antibiotics for the common cold 1, 2
- No evidence of benefit and significant risk of adverse effects 1
- Contribute to antibiotic resistance 2
Other Ineffective Treatments
- Nasal corticosteroids - current evidence does not support their use for common cold 1
- Echinacea products - not shown to provide significant benefits 1
- Steam/heated humidified air - no proven benefits 1
- Vaccines - no conclusive results to support their use for preventing common cold 1
Special Considerations
Duration and Expectations
- Common cold is self-limiting and typically resolves within 7-10 days, though symptoms can last up to 2 weeks 2
- Patient education about the viral nature and expected duration is crucial to manage expectations 2
Prevention Strategies
- Regular, moderate-intensity exercise may help prevent common colds 1
- Hand hygiene reduces virus transmission 6
- Probiotics may be beneficial for prevention, though evidence quality is low 1
When to Seek Further Care
Advise patients to follow up if:
- Symptoms worsen or exceed 2 weeks duration 2
- High fever (>39°C) develops with purulent nasal discharge or facial pain lasting ≥3 days 2
- Symptoms worsen after initial improvement (suggesting possible bacterial superinfection) 2
Caution in Children
- Over-the-counter cold medications should not be used in children younger than 4 years due to potential harm and lack of proven benefit 6, 7
- For children, safer options include honey (for children ≥1 year), nasal saline irrigation, and acetylcysteine 7
Remember that the common cold is self-limiting, and treatment should focus on symptom relief rather than attempting to shorten the illness duration, which is largely determined by the body's immune response to the viral infection.