What is the recommended treatment for a patient with a common cold using sodium chloride (NaCl) nasal drops?

Sodium Chloride (Saline) Nasal Drops for Common Cold

Nasal saline irrigation provides modest but clinically meaningful symptom relief for common cold, particularly in children, and should be recommended as a safe adjunctive treatment alongside other symptomatic therapies. 1, 2

Evidence for Saline Nasal Drops

Efficacy and Mechanism

• Nasal saline irrigation is beneficial for relieving cold symptoms, with buffered hypertonic saline (3-5%) demonstrating superior anti-inflammatory effects compared to isotonic saline (0.9%) 2
• Both isotonic saline (0.9%) and hypertonic seawater (2.3%) solutions significantly improve nasal congestion, weakness, sleep quality, and nutrition compared to no treatment in children under 2 years with acute upper respiratory infection 3
• There is no significant difference in effectiveness between standard saline (0.9%) and seawater (2.3%) solutions, meaning either can be used based on availability and cost 3

Clinical Application

• Saline drops should be added to standard treatment protocols for common cold as an adjunctive measure 3
• The benefit is particularly notable in children, where saline irrigation is one of the few established safe and effective treatments 4
• Saline works by mechanically clearing secretions and reducing mucosal inflammation, without the risk of rebound congestion seen with decongestants 2

Positioning Within Treatment Algorithm

First-Line Approach for Mild Symptoms

• For isolated nasal congestion, consider short-term decongestants (oral or topical, limited to 3-5 days) as first-line for rapid relief in adults 1, 2
• Add saline nasal irrigation as an adjunctive measure to enhance symptom control 1, 2

For Children

• Saline nasal irrigation is a primary recommended treatment since OTC decongestants should be avoided in children under 6 years due to lack of efficacy and potential toxicity 2, 4
• Other safe pediatric options include honey (for children ≥1 year), acetylcysteine, and topical ointments containing camphor/menthol/eucalyptus 4

For Multiple Symptoms in Adults

• Use combination antihistamine-analgesic-decongestant products for significant multi-symptom relief (approximately 1 in 4 patients experience significant improvement) 1
• Add saline irrigation for additional nasal symptom control 1
• Consider ipratropium bromide nasal spray specifically for rhinorrhea (runny nose), though it does not help nasal congestion 5, 1, 2

Important Caveats

What NOT to Use

• Intranasal corticosteroids have no evidence supporting their use for common cold symptom relief and should not be recommended 5, 2
• Antibiotics provide no benefit and contribute to antimicrobial resistance 5, 1, 2
• Antihistamines alone have limited benefit for cold symptoms 1

Safety Considerations

• Saline has an excellent safety profile with no significant adverse effects, making it ideal for all age groups including young children 4, 3
• Unlike decongestants, saline can be used repeatedly without risk of rebound congestion or rhinitis medicamentosa 2
• Hypertonic saline (2.3-5%) may cause mild transient stinging but is generally well-tolerated 2, 3

Practical Implementation

• Administer saline drops 2-4 times daily as needed for symptom relief 3
• Either isotonic (0.9%) or hypertonic (2.3-5%) formulations are effective; hypertonic may provide slightly better anti-inflammatory effects 2
• Combine with other evidence-based treatments: NSAIDs for pain/fever, zinc lozenges if within 24 hours of symptom onset (≥75 mg/day), and short-term decongestants for severe congestion in adults 1, 2