What are the recommended treatments for a cold?

Treatment of the Common Cold

For symptomatic relief of the common cold, use combination antihistamine-decongestant-analgesic products as first-line therapy, which provide significant improvement in approximately 1 in 4 patients, and avoid antibiotics entirely as they provide no benefit and contribute to antimicrobial resistance. 1

First-Line Treatment Approach

Combination products are superior to single agents when multiple cold symptoms are present (nasal congestion, rhinorrhea, headache, malaise). 1, 2 The American College of Physicians specifically recommends antihistamine-analgesic-decongestant combinations for adults and older children. 1

For patients preferring targeted single-symptom treatment:

• Nasal congestion: Use oral decongestants (pseudoephedrine) or topical nasal decongestants (oxymetazoline) for short-term relief only—strictly limit to 3 days maximum to avoid rebound congestion 1, 2
• Rhinorrhea (runny nose): Ipratropium bromide nasal spray is highly effective, though it does not improve congestion 1, 2
• Pain, fever, headache, body aches: NSAIDs (ibuprofen, naproxen) or acetaminophen—NSAIDs additionally improve sneezing symptoms 1, 2, 3
• Cough: Simple home remedies like honey and lemon, adequate hydration, and menthol lozenges are recommended over cough suppressants, which have limited efficacy for URI-related cough 4, 1

Evidence-Based Adjunctive Therapies

Zinc lozenges (≥75 mg/day) significantly reduce cold duration if started within 24 hours of symptom onset. 1, 2 This timing is critical—zinc is ineffective if started later. Potential side effects include bad taste and nausea. 1

Additional helpful measures:

• Nasal saline irrigation provides modest symptom relief without drug interactions 1, 2
• Vitamin C may be worth trying given its consistent effect on duration and severity, low cost, and safety profile 1, 2

Treatments to Avoid

Never use antibiotics for uncomplicated common cold—they have no evidence of benefit and are associated with significant adverse effects while contributing to antimicrobial resistance. 1, 2 This remains true even when phlegm is present, as approximately 25% of patients have symptoms lasting up to 14 days, which is normal viral course and does not indicate bacterial infection. 2

Other ineffective treatments to avoid:

• Newer non-sedating antihistamines (loratadine, cetirizine, fexofenadine) are ineffective for cold symptoms 1, 2
• Intranasal corticosteroids provide no symptomatic relief 1, 2
• Echinacea products have not been shown to provide benefits 1, 2
• Codeine and dextromethorphan have limited efficacy for URI-related cough despite being effective in chronic bronchitis 4, 1

Clinical Course and When to Reassess

Cold symptoms typically last 7-10 days, with 25% of patients experiencing symptoms for up to 14 days—this is normal and does not indicate bacterial infection. 2 Only 0.5-2% of viral upper respiratory infections develop bacterial complications. 2

Reassess the patient if:

• Symptoms worsen after initial improvement 2
• Symptoms persist beyond 10 days without any improvement (post-viral rhinosinusitis) 2
• High fever develops 2

Common Pitfalls to Avoid

• Inappropriate antibiotic prescribing based on symptom duration alone or patient/family pressure—symptom duration up to 14 days is normal viral course 1, 2
• Prolonged decongestant use leading to rebound congestion—strictly limit to 3 days 1, 2
• Missing the 24-hour window for zinc supplementation effectiveness 1, 2
• Unrealistic expectations—counsel patients that cold symptoms typically last up to 2 weeks 1