What medications can be suggested for an adult or child over 6 years old with no underlying medical conditions presenting with typical cold symptoms, such as runny nose, congestion, and cough?

Medication Recommendations for Cold Symptoms

For adults and children over 6 years with typical cold symptoms, recommend oral decongestants (pseudoephedrine or phenylephrine) for nasal congestion, acetaminophen or NSAIDs for pain/malaise, and first-generation antihistamine-decongestant combinations for overall symptom relief, while avoiding antibiotics entirely and limiting topical nasal decongestants to 3 days maximum. 1

Age-Specific Critical Safety Point

Do not recommend any over-the-counter cough and cold medications for children under 6 years of age due to lack of efficacy and documented fatalities—between 1969-2006, there were 54 deaths from decongestants and 69 deaths from antihistamines in children under 6 years. 1, 2

Recommended Medications by Symptom

For Nasal Congestion

• Oral decongestants (pseudoephedrine or phenylephrine) provide small but positive effects on subjective nasal congestion in adults 1
• Multiple doses are more effective than single doses 1
• Topical nasal decongestants (oxymetazoline, xylometazoline) work quickly and effectively but must be limited to 3 days maximum to prevent rhinitis medicamentosa (rebound congestion), which can develop as early as day 3-4 of use 1

For Runny Nose (Rhinorrhea)

• Ipratropium bromide nasal spray is the most effective option specifically for rhinorrhea, though it causes mild self-limiting side effects and does not help congestion 1
• Acetaminophen may help reduce rhinorrhea as a secondary benefit 1

For Pain, Headache, and Malaise

• Acetaminophen helps relieve nasal obstruction and rhinorrhea but does not improve sore throat, malaise, sneezing, or cough 1
• NSAIDs (ibuprofen, naproxen) provide significant benefits for headache, ear pain, muscle/joint pain, and borderline benefit for malaise; they also improve sneezing but not cough or nasal discharge 1
• The American College of Chest Physicians strongly recommends naproxen for acute cough from common cold unless contraindicated (glaucoma, BPH, hypertension, renal failure, GI bleeding, heart failure) 1

For Multiple Symptoms

• First-generation antihistamine-decongestant-analgesic combinations provide general benefit in adults and older children (over 6 years) for overall cold symptoms, particularly effective in the first 1-2 days 1
• The American College of Chest Physicians strongly recommends first-generation antihistamine/decongestant combinations over newer nonsedating antihistamines, which are ineffective for cold symptoms 1
• Benefits must be weighed against sedation and anticholinergic side effects 1

For Cough

• Dextromethorphan may provide modest benefit in adults, though evidence is limited 3
• Honey (1 teaspoon) is effective for children over 1 year old—never give to infants under 12 months due to botulism risk 4, 2, 5

What NOT to Recommend

Ineffective Medications

• Antibiotics: No benefit for common cold; cause significant adverse effects 1
• Nasal corticosteroids: Not effective for symptomatic relief from common cold 1
• Newer nonsedating antihistamines (cetirizine, loratadine, fexofenadine): Ineffective for cold symptoms despite being safer 1
• Echinacea: Not shown to provide benefits for treating colds 1
• Inhaled corticosteroids or oral steroids: No role in common cold 6

Age-Restricted Medications

• All OTC cough and cold medications in children under 4 years: No proven efficacy and potential for serious toxicity including death 4, 2
• Children 4-6 years: Generally avoid OTC cold medications; FDA advisory committees recommended against use under age 6 2

Supportive Measures with Evidence

• Nasal saline irrigation: Possibly beneficial, especially in children 1
• Zinc lozenges (acetate or gluconate ≥75 mg/day): Significantly reduces cold duration when started within 24 hours of symptom onset 1
• Vitamin C: May be worthwhile to try individually given consistent effects on duration/severity, low cost, and safety 1

Common Pitfalls to Avoid

• Prolonged topical decongestant use: Causes rhinitis medicamentosa; strictly limit to 3 days 1
• Prescribing antibiotics: No benefit and causes harm; 65-80% of acute bronchitis patients inappropriately receive antibiotics 1
• Using multiple products with same ingredients: Major cause of overdose, especially in children 2
• Recommending OTC medications for young children: Parents often expect medication, but education about self-limited nature is more appropriate 5