What treatment is recommended for a generally healthy adult with a cold and headache?

Treatment for Common Cold with Headache

For a generally healthy adult with a common cold and headache, prescribe acetaminophen 1000 mg or an NSAID (ibuprofen 400-800 mg or naproxen 500-825 mg) for symptomatic relief of headache, and advise that antibiotics are not indicated and provide no benefit. 1

Antibiotics: Not Indicated

• Do not prescribe antibiotics for the common cold. There is no evidence of benefit from antibiotics for the common cold in adults, and they cause significant adverse effects without improving outcomes. 1
• Antibiotics play no role in preventing complications of the common cold such as bacterial sinusitis, asthma exacerbation, or otitis media. 1
• Approximately 30% of common cold visits result in an inappropriate antibiotic prescription, contributing to antibiotic resistance. 1

First-Line Treatment for Headache

• Prescribe NSAIDs as first-line therapy for headache associated with the common cold. NSAIDs produce significant benefits for analgesic outcomes including headache, ear pain, and muscle/joint pain. 1
• Ibuprofen 400-800 mg every 6 hours or naproxen 500-825 mg every 2-6 hours are appropriate NSAID choices. 2, 3
• Acetaminophen 1000 mg is an alternative for patients who cannot tolerate NSAIDs, though it may help relieve nasal obstruction and rhinorrhea but does not appear to improve other cold symptoms as effectively. 1, 4

Symptomatic Therapy for Cold Symptoms

• Combination antihistamine-analgesic-decongestant products provide some general benefit in adults with common cold, with 1 out of 4 patients experiencing significant symptom relief. 1
• Multiple doses of decongestants (oral or nasal) may have a small positive effect on subjective measures of nasal congestion in adults. 1
• Ipratropium bromide is likely effective in ameliorating rhinorrhea but has no effect on nasal congestion. 1
• Nasal saline irrigation possibly has benefits for relieving symptoms of acute upper respiratory tract infections. 1

Treatments Without Evidence of Benefit

• Nasal corticosteroids do not provide symptomatic relief from the common cold. 1
• Steam or heated humidified air shows no benefits for treating the common cold. 1
• Echinacea products have not been shown to provide benefits for treating colds. 1
• Vaccines have no conclusive results supporting their use for preventing the common cold in healthy people. 1

Patient Counseling

• Advise patients that common cold symptoms can last up to 2 weeks and to follow up if symptoms worsen or exceed the expected time of recovery. 1
• Inform patients that antibiotics are not needed and may have adverse effects. 1
• The best method to reduce spread is appropriate handwashing, as direct hand contact is the most efficient means of transmission. 1

Critical Pitfall to Avoid

• Do not prescribe antibiotics for uncomplicated common cold, as this leads to significantly increased risk for adverse effects without providing benefit and contributes to antibiotic resistance. 1