What are the management options for the common cold?

Management of the Common Cold

Antibiotic treatment is not justified in uncomplicated acute common cold, as it has not been shown to affect symptom duration or prevent complications. 1, 2 Instead, management should focus on symptomatic relief through both pharmacological and non-pharmacological approaches.

Pharmacological Treatment Options

First-line Treatments

• Analgesics/Antipyretics:

  • Paracetamol (acetaminophen): 500-1000mg every 4-6 hours (max 4000mg daily) for nasal obstruction, rhinorrhea, and pain 2
  • NSAIDs (e.g., ibuprofen): Alternative for headache, ear pain, and muscle/joint pain 2

• Nasal Symptoms:

  • Decongestants (e.g., xylometazoline): Use ≤3 days to avoid rebound congestion 2
  • Ipratropium bromide nasal spray: Effective for rhinorrhea 2
  • Zinc lozenges (≥75 mg/day): Start within 24 hours of symptom onset to significantly reduce cold duration 2

• Cough Management:

  • Dextromethorphan: For short-term relief of dry cough 2, 3
  • Honey: Recommended for cough in patients older than 1 year 2

Limited Benefit Treatments

• Antihistamines: Limited short-term benefit (days 1-2) for overall symptoms, may cause drowsiness 2

Non-Pharmacological Approaches

• Nasal saline irrigation: Safe and effective for symptom relief 2, 4
• Adequate hydration and rest 2
• Regular, moderate-intensity exercise: May help prevent common colds 2
• Probiotics: May be beneficial for prevention (low-quality evidence) 2

Important Safety Considerations

Avoid in Management

• Antibiotics: No benefit for viral common cold and increase risk of adverse effects 1, 2
• Over-the-counter cold medications: Should not be used in children younger than four years 2, 4

Cautions

• Do not exceed recommended dosages of paracetamol to avoid liver damage 2
• Limit decongestant use to ≤3 days to prevent rebound congestion 2
• Be aware of combination ingredients to avoid duplicate dosing 2

Duration and Monitoring

• Common cold is self-limiting and typically resolves within 7-10 days, though symptoms can last up to 2 weeks 2
• Patients should seek medical attention if they experience:
  • Signs of bacterial complications
  • Symptoms persisting beyond 2 weeks
  • High fever developing after the first few days
  • Severe facial pain or headache
  • Shortness of breath or wheezing
  • Complete voice loss or severe hoarseness persisting more than 2-3 weeks 2

Patient Education

• Inform patients about the viral nature of the illness and expected duration of symptoms 2
• Educate about signs of possible complications requiring medical attention 1
• Emphasize that the common cold is highly contagious but self-limiting 5
• Promote hand hygiene to reduce transmission of cold viruses 6

Special Populations

• Children: Effective treatments include honey (for children ≥1 year), nasal saline irrigation, and topical application of ointment containing camphor, menthol, and eucalyptus oils 6
• Older Adults: Lactobacillus casei may be beneficial (lower-quality evidence) 6

The common cold remains one of the most frequent reasons for physician visits, with significant impact on school attendance and workplace productivity 5. While there is no cure for the viruses causing colds 7, appropriate symptomatic management can improve patient comfort during the illness.