Oral Steroids Are Not Recommended for Severe Cold Symptoms
Oral corticosteroids should not be used for the common cold, even when symptoms are severe, as current evidence shows no significant benefit for symptom relief and may increase viral replication. 1, 2
Evidence Against Steroid Use in Common Cold
Lack of Efficacy
- A Cochrane systematic review of three trials (353 participants) found that intranasal corticosteroids provided no benefit for duration or severity of common cold symptoms 1
- In one placebo-controlled trial, the mean number of symptomatic days was actually slightly longer in the corticosteroid group (10.7 days) compared to placebo (10.3 days), though this difference was not statistically significant 1
- A randomized controlled trial of oral prednisone (20 mg three times daily for 5 days) in experimental rhinovirus infections showed no significant reduction in total symptom scores despite reducing kinin levels 2
Potential Harms
- Oral prednisone significantly increased viral titers in patients with rhinovirus infections (mean viral titer 1.13 vs 0.79 in placebo, p = 0.03), with the most pronounced differences on days 3 and 4 of infection 2
- Steroid recipients experienced increased sneezing (p < 0.01) and mucus production (p < 0.05) on day 1 of treatment 2
- Short-course oral steroids are associated with increased gastrointestinal disturbances (RR 3.45,95% CI 1.11 to 10.78) and insomnia (RR 3.63,95% CI 1.10 to 11.95) 3
Important Clinical Distinction: This Is Not Sore Throat
The common cold differs fundamentally from severe pharyngitis, where limited evidence suggests potential benefit from corticosteroids in highly selected cases:
- For adults with severe sore throat (Centor score 3-4), a single dose of corticosteroids in conjunction with antibiotic therapy may provide modest symptom relief, though this is not routinely recommended 4
- This recommendation applies only to bacterial pharyngitis, not viral upper respiratory infections like the common cold 4
Recommended Symptomatic Management Instead
Since steroids are ineffective and potentially harmful for colds, focus on evidence-based symptomatic treatments:
- Dextromethorphan may benefit adults with cough, though effectiveness has not been demonstrated in children and adolescents 5
- Topical (intranasal) and oral nasal decongestants relieve nasal symptoms in adolescents and adults when used for up to three days 5
- Antihistamine/decongestant combinations can modestly improve symptoms in adults, though benefits must be weighed against side effects 5
- Humidified air and adequate fluid intake are safe supportive measures without adverse effects 5
Critical Pitfall to Avoid
Do not confuse the common cold with conditions where short-course steroids may have a role (severe bacterial pharyngitis, chronic rhinosinusitis with nasal polyps, asthma exacerbations, or COVID-19 with hypoxemia). The common cold is a self-limited viral illness where steroids provide no benefit and may prolong viral shedding. 1, 2