What is the recommended care plan for managing common colds?

Care Plan for Common Colds

Primary Management Approach

The common cold requires only symptomatic treatment with combination antihistamine-decongestant-analgesic products providing the most effective relief—antibiotics are never indicated and the illness is self-limiting, resolving in 7-10 days in most patients. 1

Initial Assessment: Rule Out Serious Conditions

Before proceeding with symptomatic management, directly ask about these danger signs that require immediate evaluation:

• Hemoptysis (any amount warrants chest radiograph and possible bronchoscopy referral) 2, 1
• Fever >38°C (100.4°F) persisting beyond 3 days or appearing after initial improvement 2, 1
• Severe breathlessness (assess for asthma or anaphylaxis) 2, 1
• "Double sickening" pattern (initial improvement followed by worsening suggests bacterial complication) 2, 1
• Suspected foreign body inhalation (mandatory bronchoscopy referral) 2, 1
• Severe unilateral facial pain with purulent discharge (suggests bacterial sinusitis) 1

Critical pitfall to avoid: 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. 1

First-Line Symptomatic Treatment

Combination Products (Most Effective)

Use combination antihistamine-decongestant-analgesic products as first-line therapy because they provide superior 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). 1

• Specific effective combination: First-generation antihistamine (brompheniramine) + sustained-release pseudoephedrine reduces congestion and rhinorrhea 1
• Important: Newer nonsedating antihistamines are ineffective and should not be used 2, 1

Individual Symptom Management

For nasal congestion:

• Oral decongestants (pseudoephedrine or phenylephrine) provide modest benefit 1, 3
• Topical nasal decongestants are effective but limit use to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa) 1

For rhinorrhea:

• Ipratropium bromide nasal spray effectively reduces rhinorrhea but does not improve nasal congestion 1, 4

For pain, headache, and malaise:

• NSAIDs (ibuprofen 400-800 mg every 6-8 hours) are effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing 1
• Acetaminophen/paracetamol may help nasal obstruction and rhinorrhea but does not improve sore throat, malaise, or other symptoms 1, 5

For cough:

• Dextromethorphan at 60 mg for maximum effect (standard OTC doses are likely subtherapeutic) 2, 1, 6
• Menthol inhalation provides acute but short-lived cough suppression 2, 1
• Honey and lemon is recommended as a simple, inexpensive home remedy with patient-reported benefit 2, 1
• Avoid opiate antitussives (codeine, pholcodine) due to significant adverse effects without clear superiority 2, 1, 6

Adjunctive Therapies with Evidence

Zinc lozenges (≥75 mg/day) significantly reduce cold duration BUT only if started within 24 hours of symptom onset—no benefit if symptoms already established beyond 24 hours. 1 Use zinc acetate or zinc gluconate formulations. 1 Potential side effects include bad taste and nausea. 1

Nasal saline irrigation provides modest symptom relief, particularly beneficial in children, by diluting secretions and facilitating elimination. 1, 3

What Does NOT Work (Avoid These)

• Antibiotics have no benefit for uncomplicated common cold and contribute to antimicrobial resistance 2, 1
• Intranasal corticosteroids for acute cold symptoms 1, 3
• Non-sedating antihistamines (newer generation) are ineffective 2, 1
• Codeine has not been shown to effectively treat cold-related cough 6

When Symptoms Persist Beyond 10 Days

Approximately 25% of patients continue with cough and nasal discharge up to 14 days—this is normal and does not indicate bacterial infection. 1

Management approach:

• Continue symptomatic treatment with combination products 1
• Consider intranasal corticosteroids for post-viral symptoms 1
• Only suspect bacterial infection if at least 3 of 5 criteria are present: discolored (purulent) nasal discharge, severe local pain, fever >38°C (100.4°F), "double sickening" pattern, elevated inflammatory markers 1
• Key point: Only 0.5-2% of viral URIs develop bacterial complications 1

Patient Education

Inform patients that:

• Cold symptoms typically last 7-10 days, with up to 25% having symptoms for 14 days 2, 1
• The illness is self-limiting and viral—antibiotics will not help 2, 1
• Most effective prevention: Washing hands thoroughly with soap and water before and after contact with sick individuals or contaminated surfaces 7
• Stay home when symptomatic to prevent transmission—people are most infectious soon after symptoms develop and continue shedding virus for 5 days 7

Special Populations

Pregnant women: Acetaminophen/paracetamol is first-line for pain and fever 1

Children: Acetaminophen/paracetamol for fever and pain; over-the-counter cold medications should not be used in children younger than four years due to potential harm without benefit 3, 4