What if common cold symptoms persist for more than 7 days?

Management of Common Cold Symptoms Lasting More Than Seven Days

If common cold symptoms persist beyond seven days, it should be classified as post-viral rhinosinusitis, which requires symptomatic treatment and monitoring for potential bacterial complications rather than antibiotics. 1

Diagnostic Considerations for Prolonged Cold Symptoms

• Common cold symptoms typically last 7-10 days, with approximately 25% of patients experiencing symptoms like cough and nasal discharge for up to 14 days 2
• When symptoms persist beyond 10 days without improvement, this is classified as post-viral rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) guidelines 1
• Persistent symptoms do not automatically indicate bacterial infection; only 0.5-2% of viral upper respiratory infections develop bacterial complications 1

Warning Signs That Require Medical Evaluation

• Fever above 38°C (100.4°F), especially if occurring after day 3 or persisting 1
• Severe unilateral facial pain 1
• "Double sickening" (initial improvement followed by worsening symptoms) 1
• Discolored mucus with at least two other signs of bacterial infection 1
• Symptoms worsening after 5-7 days rather than improving 1, 2

Appropriate Management for Prolonged Cold Symptoms

• Antibiotics are not justified for uncomplicated cold symptoms, even when prolonged beyond 7 days 1
• Symptomatic treatment should continue with:
  • Combination antihistamine-analgesic-decongestant products (provide significant relief in 1 of 4 patients) 1, 3
  • NSAIDs for pain, headache, and malaise 3, 2
  • Short-term nasal decongestants (no longer than 3-5 days to avoid rebound congestion) 3, 2
  • Saline nasal irrigation to alleviate congestion 3, 2

Special Considerations for Prolonged Symptoms

• Intranasal corticosteroids may be beneficial if symptoms suggest post-viral rhinosinusitis (symptoms >10 days) 1
• Zinc supplementation is only effective if started within 24 hours of symptom onset and is not helpful for already prolonged symptoms 3, 2
• Patients should be informed that approximately 25% of colds can last up to 14 days, particularly symptoms like cough and nasal discharge 2, 4

When to Consider Bacterial Rhinosinusitis

Bacterial rhinosinusitis should be suspected if at least 3 of these 5 criteria are present:

• Discolored (purulent) nasal discharge 1
• Severe local pain (often unilateral) 1
• Fever >38°C (100.4°F) 1
• "Double sickening" (worsening after initial improvement) 1
• Elevated inflammatory markers (if tested) 1

Common Pitfalls to Avoid

• Prescribing antibiotics for viral or post-viral rhinosinusitis, which provides no benefit and increases risk of adverse effects 1
• Using decongestant nasal sprays beyond 3-5 days, which can lead to rebound congestion 3, 2
• Failing to recognize that persistent symptoms (up to 14 days) can be normal in the course of a common cold, especially in children 2, 4
• Overlooking potential complications that require medical attention, such as sinusitis, otitis media, or lower respiratory infections 1, 2