What is the recommended treatment for the common cold?

Treatment of the Common Cold

The common cold should be treated with symptomatic therapy only, as antibiotics are ineffective and potentially harmful for this self-limited viral illness. 1

Understanding the Common Cold

• The common cold is a benign, self-limited viral upper respiratory tract infection that typically includes symptoms such as sneezing, rhinorrhea, sore throat, cough, low-grade fever, headache, and malaise 1
• Symptoms typically last up to 2 weeks, and patients should be advised to follow up if symptoms worsen or exceed this expected recovery time 1
• The most efficient transmission is through direct hand contact, making appropriate handwashing the best method to reduce spread 1

First-Line Symptomatic Treatments

For Adults:

• Combination products: Antihistamine-analgesic-decongestant combinations provide significant symptom relief in approximately 25% of patients 1
• Analgesics:
  • Acetaminophen/paracetamol helps relieve nasal obstruction and rhinorrhea 1, 2
  • NSAIDs provide relief for headache, ear pain, muscle/joint pain, and malaise 1, 3
• Decongestants:
  • Oral or nasal decongestants (pseudoephedrine, phenylephrine) may have a small positive effect on nasal congestion 1, 4
  • Should only be used short-term to avoid rebound congestion 1
• Zinc supplements:
  • Zinc acetate or gluconate lozenges (≥75 mg/day) taken within 24 hours of symptom onset can reduce duration of symptoms 1
  • Benefits must be weighed against side effects like nausea and bad taste 1
• Ipratropium bromide: Effective for reducing rhinorrhea but does not affect nasal congestion 1, 5

For Children:

• Important caution: Over-the-counter cold medications should NOT be used in children under 4 years due to potential harm and lack of benefit 6
• Safe options for children:
  • Honey (for children over 1 year) 5
  • Nasal saline irrigation 1, 5

Second-Line or Adjunctive Treatments

• Vitamin C: May reduce duration and severity of symptoms when taken regularly; can be tried on an individual basis 1
• Nasal saline irrigation: Possibly beneficial for relieving symptoms, especially in children 1
• Herbal preparations: Some preparations like BNO1016 (Sinupret), Cineole, and Andrographis paniculata SHA-10 extract may have a positive impact on symptoms 1

Treatments NOT Recommended

• Antibiotics: No evidence of benefit for the common cold; increases risk of adverse effects 1
• Intranasal corticosteroids: Current evidence does not support their use for symptomatic relief of the common cold 1
• Echinacea: Most products have not been shown to provide significant benefits 1
• Steam/heated humidified air: No evidence of benefits or harm 1
• Vitamin C or herbal remedies: Limited evidence supporting their use 1

Patient Education Points

• Inform patients about the self-limited nature of the common cold (up to 2 weeks) 1
• Explain that antibiotics are ineffective against viral infections and may cause harm 1
• Advise on proper hand hygiene to prevent transmission 1
• Recommend follow-up if symptoms worsen or exceed the expected recovery time 1
• Explain that symptomatic treatments may provide relief but will not cure or shorten the illness significantly 1, 5

Common Pitfalls to Avoid

• Prescribing antibiotics for viral infections, which contributes to antibiotic resistance 1
• Using decongestants for longer than recommended, which can lead to rebound congestion 1
• Giving honey to children under 1 year of age (risk of infant botulism) 5
• Using OTC cold medications in children under 4 years 6
• Expecting complete resolution of symptoms with any treatment, as the illness must run its course 1