Treatment Recommendations for the Common Cold

Symptomatic therapy is the appropriate management strategy for the common cold, as antibiotics are ineffective and should not be prescribed. 1

Understanding the Common Cold

The common cold is a self-limiting viral illness that typically resolves within 7-10 days 2
Symptoms include sneezing, rhinorrhea, sore throat, cough, low-grade fever, headache, and malaise 1
Multiple viruses cause the common cold, with transmission occurring primarily through direct hand contact, making handwashing the best method to reduce spread 1
Approximately 25% of patients may continue with symptoms such as cough and nasal secretion up to 14 days 2

Analgesics may be offered for pain, and antipyretics for fever 1
NSAIDs can provide significant benefits for headache, ear pain, muscle and joint pain, and show borderline benefit for malaise 1
Paracetamol (acetaminophen) may help relieve nasal obstruction and rhinorrhea but does not improve other cold symptoms 1

Multiple doses of decongestants may have a small positive effect on subjective measures of nasal congestion in adults 1
Nasal decongestants should only be used for short periods (3-5 days) to avoid rebound congestion 2
Systemic or topical decongestants may provide symptomatic relief 1

Combination antihistamine-analgesic-decongestant products provide significant symptom relief in 1 out of 4 patients 1
These combinations have some general benefit in adults and older children with common cold, but benefits must be weighed against the risk of adverse effects 1

Antihistamines have a limited short-term (days 1 and 2 of treatment) beneficial effect on severity of overall symptoms in adults 1
When used alone, antihistamines have more adverse effects than benefits 1

Ipratropium bromide is recommended for cough suppression in patients with cough due to URI 1
Ipratropium bromide is likely effective in ameliorating rhinorrhea but has no effect on nasal congestion 3
Saline nasal irrigation possibly has benefits for relieving symptoms, especially in children 1

Zinc administered as zinc acetate or zinc gluconate lozenges at a dose of ≥75 mg/day and taken within 24 hours of symptom onset can significantly reduce the duration of common cold 1
Potential benefits should be weighed against adverse reactions such as nausea and bad taste 1

Antibiotics should not be prescribed for patients with the common cold 1
Antibiotics are not effective and lead to significantly increased risk for adverse effects 1
Antibiotics do not prevent complications of the common cold such as acute bacterial sinusitis, asthma exacerbation, and otitis media 1

Nasal corticosteroids are not supported for use in symptomatic relief from the common cold 1
Steam/heated humidified air shows no benefits for treatment of the common cold 1
Vitamin C may be worth trying on an individual basis, but evidence for consistent benefit is limited 1
Echinacea products have not been shown to provide benefits for treating colds 1

Inform patients that symptoms can last up to 2 weeks 1
Advise patients to follow up if symptoms worsen or exceed the expected time of recovery 1
Explain the viral origin of the illness and the usually favorable outcome 1
Educate about signs of possible complications that would warrant further evaluation 2

Fever persisting more than 3 days or occurring after this period 2
Persistence of symptoms (cough, rhinorrhea, nasal obstruction) after 10 days with no signs of improvement 2
Development of severe symptoms or signs of high fever (>39°C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days 1