What is the recommended management for an otherwise healthy adult suspected of having a common cold?

Management of Common Cold in Adults

The common cold requires only symptomatic treatment—antibiotics should never be prescribed as they provide no benefit and cause significant adverse effects. 1

Core Management Principles

Symptomatic therapy is the only appropriate management strategy for the common cold. 1 The illness is self-limited, typically resolving within 7-10 days, though symptoms can persist up to 2 weeks in approximately 25% of patients. 1, 2

Patient Education (Critical First Step)

• Inform patients that the common cold is viral in origin and self-limited 1
• Set realistic expectations: symptoms typically last 7-14 days 1, 2
• Advise follow-up only if symptoms worsen or exceed expected recovery time 1
• Emphasize that antibiotics are not needed and may cause harm 1
• Teach proper handwashing as the most effective prevention method 1

First-Line Symptomatic Treatment

For Multiple Symptoms

Use combination antihistamine-analgesic-decongestant products, which provide significant relief in approximately 1 in 4 patients. 3, 4 Specifically, first-generation antihistamine (brompheniramine) with sustained-release pseudoephedrine is recommended. 1, 4

For Single Predominant Symptoms

Nasal Congestion:

• Oral or topical decongestants (pseudoephedrine or phenylephrine) provide modest benefit 3
• Critical caveat: Use only short-term (3-5 days maximum) to avoid rebound congestion 3

Rhinorrhea (Runny Nose):

• Ipratropium bromide nasal spray is highly effective for reducing rhinorrhea 3, 5
• May cause minor side effects like nasal dryness 3

Pain, Fever, Headache, Malaise:

• NSAIDs (ibuprofen 400-800 mg every 6-8 hours) are effective for headache, ear pain, muscle/joint pain, malaise, and also improve sneezing 3, 4
• Acetaminophen may help relieve nasal obstruction and rhinorrhea but does not improve other symptoms 3

Additional Evidence-Based Therapies

Zinc lozenges (≥75 mg/day):

• Must be started within 24 hours of symptom onset to be effective 3, 4
• Significantly reduce cold duration 3
• Potential side effects include bad taste and nausea 3

Nasal saline irrigation:

• Provides modest symptom relief 3, 4
• Safe and can be used as adjunctive therapy 1

What NOT to Use

Antibiotics:

• Provide zero benefit for common cold symptoms 1
• Number needed to harm (adverse effects) is only 8 patients 1
• Do not prevent bacterial complications 1
• Contribute to antimicrobial resistance 1, 3

Intranasal corticosteroids:

• No evidence supporting use for common cold 3, 4

Antihistamines alone:

• Limited benefit; newer non-sedating antihistamines are ineffective 1, 3

Echinacea:

• Does not provide significant benefits 3

When to Consider Bacterial Complication

Reserve antibiotics only for confirmed bacterial complications, not routine cold symptoms. 4 Consider bacterial rhinosinusitis only if the patient meets specific criteria:

Criteria for Possible Bacterial Infection (Need ≥3 of 5):

• Discolored (purulent) nasal discharge 4, 2
• Severe unilateral facial pain 4, 2
• Fever >38°C (100.4°F) 4, 2
• "Double sickening" (initial improvement followed by worsening) 1, 2
• Elevated inflammatory markers 4, 2

OR persistent symptoms for more than 10 days without any improvement 1, 2

For Post-Viral Rhinosinusitis (>10 days):

• Consider intranasal corticosteroids for symptom relief 2
• Continue symptomatic treatment 2

Common Pitfalls to Avoid

• Prescribing antibiotics "just in case": This increases resistance and causes harm without benefit 1, 3
• Prolonged decongestant use: Limit to 3-5 days maximum to prevent rebound congestion 3
• Missing the zinc window: Zinc only works if started within 24 hours of symptom onset 3, 2
• Using OTC cough/cold medications in young children: Should not be used in children under 4 years 5, 6
• Diagnosing bacterial sinusitis too early: Do not diagnose during the first week of symptoms 1