What is the recommended treatment and dosage for cough and cold with fever?

Treatment of Cough and Cold with Fever

For adults and children over 12 years with cough, cold, and fever, use acetaminophen or ibuprofen for fever and pain relief, dextromethorphan (10-20 mL every 4 hours) for bothersome dry cough, and avoid antibiotics and most over-the-counter combination cold medications. 1, 2, 3

Fever Management

• NSAIDs (ibuprofen) or acetaminophen effectively relieve fever, headache, malaise, and myalgia associated with common cold 3, 4
• These analgesics are safe at OTC doses and show no evidence of prolonging illness duration 4
• No significant difference exists between aspirin, paracetamol, and ibuprofen for efficacy and safety in treating cold/flu symptoms in adults 4
• Avoid aspirin in feverish children due to Reye's syndrome risk 4

Cough Management

For Dry, Non-Productive Cough:

• Dextromethorphan is the preferred first-line antitussive due to superior safety profile compared to codeine 2
• Dosing for adults and children ≥12 years: 10-20 mL (2-4 teaspoonfuls) every 4 hours, maximum 6 doses per 24 hours 5, 6
• Children 6 to <12 years: 5-10 mL (1-2 teaspoonfuls) every 4 hours 5
• Children 2 to <6 years: 2.5-5 mL (½-1 teaspoonful) every 4 hours 5
• Maximum cough suppression occurs at 60 mg doses 2
• Codeine and central cough suppressants have limited efficacy for URI-related cough and are NOT recommended 1, 2

For Productive "Wet" Cough:

• Consider guaifenesin (expectorant) using same age-based dosing as above 5
• Hypertonic saline solution may help increase cough clearance in bronchitis on short-term basis 2

Alternative Options:

• First-generation antihistamines with sedative properties may help nocturnal cough 2
• Simple honey and lemon mixtures are as effective as pharmacological treatments for benign viral cough 2
• Menthol inhalation provides acute but short-lived relief 2

Nasal Congestion Management

• Nasal decongestants (pseudoephedrine, phenylephrine) can reduce nasal blockage but use only short-term 3, 7
• Topical decongestants should not be used continuously beyond 3 days due to rhinitis medicamentosa risk 1
• Intranasal corticosteroids are NOT recommended for common cold symptom relief 3
• Nasal saline irrigation may provide benefit 7

What NOT to Use

Antibiotics:

• Antibiotics provide NO benefit for common cold and should NOT be prescribed 8
• Common cold is viral; antibiotics do not reduce symptom duration or severity 8
• Antibiotics significantly increase adverse effects in adults (OR 3.6) without benefit 8

Combination OTC Cold Medications:

• Over-the-counter combination cold medications (except older antihistamine-decongestant combinations) are NOT recommended until proven effective 1
• In children <6 years, OTC cough and cold medications should be avoided due to lack of efficacy and potential toxicity 1
• Between 1969-2006, there were 54 fatalities with decongestants and 69 with antihistamines in children ≤6 years 1

Other Ineffective Treatments:

• Newer-generation non-sedating antihistamines are ineffective for common cold 3, 7
• Zinc preparations are NOT recommended for acute cough due to common cold 1
• Albuterol is NOT recommended for cough not due to asthma 1
• Inhaled corticosteroids have no role in common cold treatment 3

Special Populations

Children Under 6 Years:

• Avoid all OTC cough and cold medications 1
• Use only acetaminophen or ibuprofen for fever 1
• Consider vapor rub, buckwheat honey (>1 year old), or nasal saline 7
• Consult physician for children under 2 years before any medication 5

Children 6-12 Years:

• Use age-appropriate reduced doses of dextromethorphan 5, 6
• Acetaminophen or ibuprofen for fever 4
• Avoid combination products with multiple active ingredients 1

Red Flags Requiring Medical Attention

• Coughing up blood, prolonged fever, or feeling severely unwell require immediate medical evaluation 2
• Green or yellow sputum suggests bacterial superinfection warranting physician consultation 9
• Symptoms not resolving within typical cold timeline (7-10 days) 10
• Persistent cough beyond 2-3 weeks 9

Key Clinical Pitfalls

• Do not prescribe antibiotics for uncomplicated common cold regardless of patient demand 8
• Avoid polypharmacy—patients may inadvertently overdose on acetaminophen/ibuprofen from multiple combination products 9
• Remember that most cold symptoms are self-limited and resolve within 7-10 days without treatment 10, 8
• Be cautious with decongestants in patients with hypertension, and antihistamines in those requiring alertness 9