What are the treatment options for a person with symptoms of the common cold?

Treatment of the Common Cold

The common cold should be managed with symptomatic therapy only—antibiotics are never indicated and combination antihistamine-decongestant-analgesic products provide the most effective relief for adults with multiple symptoms. 1

Core Management Principle

The common cold is a self-limited viral illness that resolves in 7-10 days without specific treatment. 1 Antibiotics provide no benefit, increase adverse effects, and contribute to antimicrobial resistance—they should never be prescribed for uncomplicated common cold. 1

Patients should be counseled that symptoms typically last up to 2 weeks, and this duration alone does not indicate bacterial infection or need for antibiotics. 1

First-Line Symptomatic Treatment

For Multiple Symptoms (Preferred Approach)

Combination antihistamine-analgesic-decongestant products are the most effective first-line therapy, providing significant symptom relief in approximately 1 out of 4 patients. 1, 2 These combinations work better than single agents for managing the constellation of cold symptoms including nasal congestion, rhinorrhea, headache, and malaise. 1, 2

• First-generation antihistamines (such as brompheniramine) combined with sustained-release pseudoephedrine effectively reduce postnasal drainage, sneezing, throat clearing, and congestion. 1
• The European Position Paper on Rhinosinusitis confirms these combinations have general benefit in adults and older children, though benefits must be weighed against potential side effects. 1

For Targeted Single Symptoms

Nasal Congestion:

• Oral decongestants (pseudoephedrine) or topical nasal decongestants (oxymetazoline) have small positive effects on subjective nasal congestion. 1
• Critical caveat: Limit topical decongestants to short-term use only (maximum 3 days) to avoid rebound congestion. 1, 2

Rhinorrhea (Runny Nose):

• Ipratropium bromide nasal spray is highly effective for reducing rhinorrhea specifically, though it has no effect on nasal congestion. 1, 2
• Side effects are generally well-tolerated and self-limiting (nasal dryness). 1

Pain, Headache, Fever:

• NSAIDs (ibuprofen, naproxen) effectively relieve headache, ear pain, muscle/joint pain, and malaise, and also improve sneezing. 1, 2
• Paracetamol (acetaminophen) may help nasal obstruction and rhinorrhea but does not improve other cold symptoms like sore throat, malaise, or cough. 1

Cough:

• Dextromethorphan may provide modest benefit for cough suppression to help sleep, though evidence is limited. 3
• Naproxen can help decrease cough associated with the common cold. 1

Evidence-Based Adjunctive Therapies

Zinc Lozenges:

• Zinc acetate or gluconate lozenges at ≥75 mg/day significantly reduce cold duration if started within 24 hours of symptom onset. 1, 2
• This is a critical time window—zinc is only effective if initiated early. 1, 2
• Potential side effects include bad taste and nausea, which must be weighed against benefits. 1, 2

Nasal Saline Irrigation:

• Provides modest symptom relief, particularly in children, and is safe without significant adverse effects. 1, 2

Vitamin C:

• May be worth trying individually given consistent effects on duration and severity, low cost, and excellent safety profile. 1, 2
• The European Position Paper notes that while prophylactic vitamin C has some benefit, therapeutic use may be worthwhile for individual patients to test. 1

Treatments That Do NOT Work

Avoid these ineffective or harmful interventions:

• Antibiotics: No benefit for uncomplicated common cold, increase adverse effects, and promote antimicrobial resistance. 1, 2
• Newer non-sedating antihistamines (loratadine, cetirizine, fexofenadine): Ineffective for cold symptoms and should not be used. 1
• Intranasal corticosteroids: No evidence of benefit for common cold symptom relief. 1, 2
• Echinacea: Not shown to provide significant benefits for treating colds. 1, 2
• Steam/heated humidified air: No proven benefits or harms. 1
• Vaccines: No conclusive results support vaccines for preventing the common cold (unlike influenza). 1

Treatment Algorithm

Step 1: Assess symptom severity and number of symptoms

• Multiple symptoms → Combination antihistamine-decongestant-analgesic product 1, 2
• Single dominant symptom → Targeted single-agent therapy (see above) 1, 2

Step 2: Add adjunctive therapy if within 24 hours of onset

• Zinc lozenges ≥75 mg/day 1, 2

Step 3: Consider additional symptomatic relief

• Nasal saline irrigation 1, 2
• Vitamin C (individual trial basis) 1, 2

Step 4: Patient education

• Expected duration: 7-10 days (up to 14 days in 25% of patients is normal) 1
• No antibiotics needed 1
• Follow up only if symptoms worsen or persist beyond 10 days without any improvement 1

Red Flags Requiring Reassessment

Do NOT diagnose bacterial sinusitis during the first week of symptoms—viral rhinosinusitis causes sinus inflammation that appears identical to bacterial infection on imaging. 1

Consider bacterial complication or specialist referral if:

• Symptoms persist >10 days without any improvement 1
• High fever (>39°C) with purulent nasal discharge or facial pain for ≥3 consecutive days 1
• "Double sickening"—worsening symptoms after initial improvement around day 5 1
• Development of complications: acute otitis media, bacterial sinusitis, asthma exacerbation 1

Common Pitfalls to Avoid

• Prescribing antibiotics based on symptom duration alone or patient pressure—approximately 30% of common cold visits result in inappropriate antibiotic prescriptions. 1
• Prolonged decongestant use—strictly limit topical decongestants to 3 days maximum to prevent rebound congestion. 1, 2
• Missing the 24-hour window for zinc—zinc supplementation only works if started within the first day of symptoms. 1, 2
• Using newer antihistamines—these are completely ineffective for cold symptoms despite being effective for allergies. 1
• Unrealistic patient expectations—clearly communicate that symptoms lasting up to 2 weeks is normal and does not indicate treatment failure or need for antibiotics. 1

Prevention Counseling

Handwashing with soap and water is the single most effective prevention measure because the common cold spreads primarily through direct hand contact with contaminated surfaces. 4 Alcohol hand rubs are less effective against cold viruses. 4