What medications are recommended for treating the common cold?

Medication for the Common Cold

For uncomplicated common cold, use symptomatic treatment only with combination antihistamine-decongestant-analgesic products (such as first-generation antihistamine with pseudoephedrine), NSAIDs for pain/fever, and zinc lozenges (≥75 mg/day) started within 24 hours of symptom onset—antibiotics are never indicated and provide no benefit. 1, 2

Core Treatment Principles

The common cold is a self-limiting viral illness that resolves in 7-10 days without specific antiviral therapy. 3, 1 Treatment focuses exclusively on symptom relief while the immune system clears the infection. 1, 2

What Works: Evidence-Based Pharmacological Options

Combination Products (Most Effective)

• First-generation antihistamine + decongestant combinations provide superior symptom relief compared to single agents, with approximately 1 in 4 patients experiencing significant improvement (odds ratio of treatment failure 0.47,95% CI 0.33-0.67). 2
• Specifically, brompheniramine combined with sustained-release pseudoephedrine effectively reduces nasal congestion and rhinorrhea. 1, 2

Analgesics/Anti-inflammatory Agents

• NSAIDs (ibuprofen 400-800 mg every 6-8 hours) are highly effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing. 1, 2
• Acetaminophen/paracetamol may help nasal obstruction and rhinorrhea but does not improve other symptoms as effectively as NSAIDs. 2

Decongestants

• Oral pseudoephedrine or phenylephrine provide modest benefit for nasal congestion. 2
• Topical nasal decongestants are effective BUT must be limited to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa). 1, 2

Zinc Supplementation

• Zinc lozenges (≥75 mg/day as zinc acetate or zinc gluconate) significantly reduce cold duration BUT only if started within 24 hours of symptom onset. 1, 2
• Critical timing: No benefit if symptoms are already established beyond 24 hours. 2
• Potential side effects include bad taste and nausea. 2

Cough Suppression

• Ipratropium bromide nasal spray effectively reduces rhinorrhea but does not improve nasal congestion. 2
• Dextromethorphan (60 mg for maximum effect) suppresses acute cough, though standard over-the-counter doses are likely subtherapeutic. 2
• Honey and lemon is recommended as a simple, inexpensive home remedy with patient-reported benefit. 2

Non-Pharmacological Interventions

Essential Supportive Measures

• Nasal saline irrigation provides modest symptom relief, helps dilute secretions, and facilitates elimination of nasal discharge. 1, 2
• Adequate hydration helps thin secretions and supports overall recovery. 1

What Does NOT Work (Avoid These)

Antibiotics

• Antibiotic treatment is NOT justified in uncomplicated acute common cold in either adults or children (Grade B recommendation). 3
• Antibiotics have not been shown to affect symptom duration or prevent complications, even when risk factors are present. 3
• Antibiotics contribute to antimicrobial resistance without providing benefit. 2

Other Ineffective Treatments

• Intranasal corticosteroids for acute cold symptoms are ineffective. 2
• Non-sedating (newer generation) antihistamines are ineffective for common cold symptoms. 2
• Opiate antitussives should be avoided due to significant adverse effects without clear superiority. 2

Pediatric-Specific Considerations

Safe Options for Children

• Acetaminophen/paracetamol for fever and pain. 1
• Honey (for children >1 year old) is effective for cough. 2, 4
• Nasal saline irrigation is particularly beneficial in children. 2
• Acetylcysteine and topical ointment containing camphor, menthol, and eucalyptus oils are safe and effective. 4

Critical Warning

• Over-the-counter cough and cold medications should NOT be used in children younger than 4 years due to potential for harm without proven benefits. 5, 4

When to Suspect Bacterial Complications

Red Flags Requiring Reassessment

• Fever >38°C (100.4°F) persisting beyond 3 days or appearing after initial improvement. 3, 2
• Symptoms (cough, rhinorrhea, nasal obstruction) persisting after 10 days without signs of improvement. 3, 1
• Severe unilateral facial pain suggesting bacterial sinusitis. 2
• "Double sickening" pattern (initial improvement followed by worsening). 2
• Otalgia, otorrhea, purulent conjunctivitis, or eyelid edema. 3, 1

Important Context

• Approximately 25% of patients continue with cough and nasal discharge up to 14 days—this is normal and does not indicate bacterial infection. 1, 2
• Only 0.5-2% of viral upper respiratory infections develop bacterial complications. 2
• Common pitfall: Do not diagnose bacterial sinusitis in the first 10 days of symptoms—87% of patients show sinus abnormalities on CT during viral colds that resolve without antibiotics. 2

Special Population: Pregnant Women

Safe First-Line Options

• Acetaminophen/paracetamol is the first-line treatment for pain and fever during pregnancy. 1, 6
• Saline nasal irrigation and adequate hydration are recommended. 6

Use with Caution

• First-generation antihistamine/decongestant combinations with pseudoephedrine should be used cautiously despite their effectiveness in non-pregnant adults. 6
• Topical nasal decongestants only for very short periods (3-5 days maximum). 6

Patient Education Points

Set Appropriate Expectations

• Cold symptoms typically last 7-10 days. 3, 1, 2
• Up to 25% may have symptoms for 14 days. 1, 2
• The illness is self-limiting and viral—antibiotics will not help or prevent complications. 3
• Inform patients about warning signs that require reevaluation (persistent fever, worsening after initial improvement, symptoms beyond 10 days without improvement). 3, 1