Plan of Care for Acute Nasopharyngitis (Common Cold)
Do not prescribe antibiotics for acute nasopharyngitis—they provide no benefit, cause significant adverse effects, and do not prevent complications. 1, 2
Symptomatic Treatment (First-Line)
Analgesics and Antipyretics
- Acetaminophen or NSAIDs (ibuprofen) for pain relief, fever control, headache, sore throat, and malaise 2, 3
- NSAIDs are particularly effective for headache, ear pain, and muscle/joint pain associated with colds 3
Nasal Symptoms Management
- Saline nasal irrigation provides cleansing and modest symptom relief by facilitating clearance of nasal secretions 2, 3
- Nasal decongestants (e.g., oxymetazoline) may be used for severe nasal congestion, but limit to 3 days maximum to avoid rhinitis medicamentosa 3, 1
- Topical decongestants should not be used beyond 3 days as rebound congestion develops 3
Combination Therapy
- Combination antihistamine-analgesic-decongestant products provide significant symptom relief in 1 out of 4 patients treated 1
- Antihistamines alone have more adverse effects than benefits 1
Alternative Symptomatic Options
- Inhaled ipratropium bromide for rhinorrhea 1
- Antitussives for cough if needed 1
- Zinc supplements (≥75 mg/day as acetate or gluconate lozenges) started within 24 hours of symptom onset may reduce duration, but weigh benefits against adverse effects (nausea, bad taste) 1
Patient Education
Expected Course
- Symptoms typically last up to 2 weeks and are self-limited 1, 2, 3
- The illness resolves without antibiotics, even when bacterial pathogens are present 1
Infection Control
- Hand hygiene is the most effective method to reduce transmission 1
- Avoid direct hand contact and contact with contaminated surfaces 1
What Does NOT Work
- Antibiotics are ineffective against viral infections and do not prevent complications such as bacterial sinusitis, asthma exacerbation, or otitis media 1, 2
- Vitamin C and echinacea have no proven benefit 1
When to Return for Reassessment
Instruct patients to follow up if:
- Symptoms persist ≥10 days without improvement 1, 2
- High fever ≥39°C with purulent nasal discharge or facial pain for ≥3-4 consecutive days 2
- Worsening symptoms after initial improvement (double sickening) 1, 2
These criteria suggest possible secondary bacterial infection (acute bacterial rhinosinusitis) requiring antibiotic consideration 1, 2
Special Considerations for Children
- Avoid decongestants and antihistamines in children under 3 years due to possible adverse effects 2
- Testing for bacterial pathogens is not routinely indicated in young children 2
Common Pitfalls to Avoid
- Do not prescribe antibiotics based on purulent nasal discharge alone—this is a normal feature of viral colds 1, 2
- Do not use intranasal corticosteroids for common cold symptomatic relief (no evidence of benefit) 1
- Ensure patients understand that antibiotics increase adverse effects without providing benefit 1, 2