What are the typical symptoms, duration, and supportive management for an uncomplicated common cold infection?

Common Cold: Symptoms and Clinical Course

Typical Symptom Presentation and Timeline

The common cold presents with a predictable pattern of symptoms that evolve over 7-14 days, with sore throat and fever resolving earliest (days 3-5), while nasal congestion and cough persist longest, commonly continuing into the second and third week in approximately 25% of patients. 1, 2

Early Phase Symptoms (Days 1-3)

• Sore throat peaks early and typically resolves by day 3-4 of illness 2
• Fever and myalgia resolve within the first 5 days 1, 2
• Sneezing, rhinorrhea, and nasal congestion begin 1
• Postnasal drip, ear fullness, and facial pressure may develop 1
• Fever is common in children during the first 3 days but less frequent in adults 3

Mid-to-Late Phase Symptoms (Days 4-14)

• Nasal congestion and cough are the most persistent symptoms, commonly continuing into the second and third week 1, 2
• Approximately 25% of patients experience symptoms for up to 14 days—this is entirely normal and does not indicate bacterial infection 2, 4
• Mucopurulent (colored) nasal secretions commonly appear after a few days due to neutrophil influx; this is a normal part of viral infection and does not indicate bacterial superinfection 1, 2
• Cough may persist with 50% of patients still symptomatic at day 10 1

Duration by Age Group

• Mean duration ranges from 6.6 days (1-2 year-olds in home care) to 8.9 days (1 year-olds in daycare) 1
• Upper respiratory symptoms may last more than 15 days in 7-13% of children, with higher rates in daycare settings 1
• In adults, colds typically last less than a week, but in preschool children they last 10-14 days 3

Supportive Management

Use combination antihistamine-decongestant-analgesic products as first-line therapy, as they provide superior relief compared to single agents, with 1 in 4 patients experiencing significant improvement. 2

First-Line Symptomatic Treatments

• Combination products containing first-generation antihistamine (brompheniramine) + sustained-release pseudoephedrine + analgesic reduce congestion, rhinorrhea, and pain (odds ratio of treatment failure 0.47; NNTB 5.6) 2
• NSAIDs (ibuprofen 400-800 mg every 6-8 hours) effectively treat headache, ear pain, muscle/joint pain, malaise, and also improve sneezing 2
• Oral decongestants (pseudoephedrine or phenylephrine) provide modest benefit for nasal congestion 2
• Topical nasal decongestants are effective but must be limited to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa) 2

Additional Effective Therapies

• Ipratropium bromide nasal spray effectively reduces rhinorrhea but does not improve nasal congestion 2
• Dextromethorphan (60 mg for maximum effect) suppresses acute cough, though standard over-the-counter doses are likely subtherapeutic 2
• Nasal saline irrigation provides modest symptom relief, particularly beneficial in children 2, 5
• Honey (for children ≥1 year old) and lemon is recommended as a simple, inexpensive home remedy with patient-reported benefit 2, 5

Time-Sensitive Therapy

• Zinc lozenges (≥75 mg/day of zinc acetate or gluconate) significantly reduce cold duration by 2-3 days BUT only if started within 24 hours of symptom onset 2, 4
• No benefit if symptoms have been present beyond 24 hours 2, 4
• Approximately 50% of patients experience bad taste and nausea 2

Pediatric-Specific Management

• Acetaminophen/paracetamol for fever and pain 2
• Honey for children ≥1 year old 2, 5
• Nasal saline irrigation 2, 5
• Topical ointment containing camphor, menthol, and eucalyptus oils 5
• Avoid over-the-counter cold medications in children younger than 4-6 years 5, 6

Critical Clinical Pitfalls

What Does NOT Work (Avoid These)

• Antibiotics have no benefit for uncomplicated common cold and contribute to antimicrobial resistance 2, 4, 5
• Intranasal corticosteroids for acute cold symptoms are ineffective 2, 7
• Systemic corticosteroids provide no benefit and increase infection risk 7
• Non-sedating antihistamines (newer generation) are ineffective 2

Common Misunderstandings

• Colored nasal discharge does NOT indicate bacterial infection—it is a normal part of the viral cold course due to neutrophil influx 1, 2
• Duration beyond 7 days does NOT automatically warrant antibiotics—symptoms persisting 10-14 days are consistent with uncomplicated viral infection 1, 2, 4
• Only 0.5-2% of viral upper respiratory infections develop bacterial complications 2, 4

When to Suspect Bacterial Complications

Bacterial rhinosinusitis should be suspected only if at least 3 of the following 5 criteria are present: 2, 4

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

Additional Red Flags Requiring Evaluation

• Fever >38°C persisting beyond 3 days or appearing after initial improvement 2
• Hemoptysis (any amount warrants chest radiograph) 2
• Acute breathlessness 2
• Symptoms persisting beyond 10 days without any improvement may warrant intranasal corticosteroids for post-viral rhinosinusitis 4

Patient Education Points

• The common cold is self-limiting and viral—antibiotics will not help 2, 5
• Typical duration is 7-10 days, but up to 25% of patients have symptoms for 14 days 2, 4
• Sore throat resolves earliest (days 3-4), while cough and nasal congestion persist longest 1, 2
• Good hand hygiene is the best prevention method 5, 8