Treatment of the common cold- dignostic guidelines for healthcare professionals

Key points

• The common cold is self-limited: symptoms often last up to 10 days, and in children who receive medical care the median duration is 8 days, with 90% of cases resolving within 23 days.
• Antibiotics are ineffective for the common cold in adults and children and should not be prescribed.
• In adults, effective treatments are over-the-counter analgesics, decongestants with or without antihistamines (but not antihistamine monotherapy), zinc, and inhaled ipratropium for persistent cough.
• In children, safe and effective options include nasal saline irrigation, analgesics, acetylcysteine, intranasal ipratropium, honey (12 months and older) and an ointment with camphor, menthol and eucalyptus oils; over-the-counter cold medications should not be used under 4 years.
• Good hand hygiene, especially hand sanitizer, is the most effective prevention.

Overview

This American Family Physician review summarizes the evidence on preventing and treating the common cold (acute upper respiratory tract infection) in adults and children. Few treatments are both safe and effective, so explaining the self-limited course helps manage expectations, limit antibiotic use and avoid over-the-counter purchases that may not help. Typical symptoms are nasal congestion, rhinorrhea, sore throat, cough, general malaise and/or low-grade fever.

Course and differential diagnosis

Viruses such as rhinovirus are the predominant cause, and transmission occurs through contact with the nasal secretions and saliva of infected people. The common cold should be distinguished from allergic rhinitis, isolated pharyngitis, acute bronchitis (mean duration 18 days in adults and 12 days in children), influenza, bacterial sinusitis and pertussis. The primary goals of treatment are to reduce symptom duration and severity.

Prevention

Good hand hygiene is the most effective and practical prevention in children and adults; hand sanitizer is more protective than hand washing and is associated with shorter symptoms and fewer school absences. Washing hands several times a day for at least 15 to 30 seconds can help prevent illness, and regular soap is as effective as antibacterial soap. Ginseng, echinacea, adenovirus vaccination, vitamin C or D, probiotics and water gargles have limited or no preventive effect.

Treatment in adults

Nonsteroidal anti-inflammatory drugs, mainly ibuprofen, reduce headache, ear, muscle and joint pain and sneezing, but not cough, cold duration or total symptom score; acetaminophen may give short-term relief of rhinorrhea and nasal obstruction. Decongestants may relieve congestion, but patients should be warned about rhinitis when intranasal oxymetazoline is used for more than 3 days. Inhaled ipratropium is the only medication that improves persistent cough after the infection, and at least 75 mg per day of zinc acetate or gluconate lozenges started within 24 hours relieves cough and nasal discharge more quickly. Not recommended: antibiotics, antivirals, most cough medications, antihistamine monotherapy, intranasal corticosteroids, steam, vitamins D and E, echinacea and Pelargonium sidoides.

Treatment in children

Nasal saline irrigation, analgesics and time are the mainstays; ibuprofen may be more effective than acetaminophen for fever-related discomfort. Acetylcysteine may decrease cough after 6 to 7 days in children 2 years and older, and intranasal ipratropium reduces rhinorrhea but not congestion in children 5 years and older and should not be used below that age. Ointment with camphor, menthol and eucalyptus oils at bedtime relieves congestion and night cough, and menthol is safe from 2 years. Honey before bedtime may reduce cough but should not be given under 12 months because of the risk of botulinum spores. Antibiotics, dextromethorphan, codeine, antihistamines, oral albuterol, steam, vitamin D and echinacea do not help, and low-quality studies suggest that increasing fluid intake may cause harm.

Frequently asked questions

Should antibiotics be prescribed for a cold?

No. They do not reduce the severity or duration of symptoms, even when purulent rhinitis is present.

Can over-the-counter cold medicines be given to young children?

Not under 4 years, because of lack of benefit and low but significant mortality rates associated with their use in this age group.

When does zinc help?

In adults, at least 75 mg per day of zinc acetate or gluconate lozenges started within 24 hours of symptom onset relieves cough and nasal discharge more quickly; in children, trials showed little or no clinically significant benefit.

Source

DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the Common Cold. American Family Physician 2019;100(5):281-289. The online version is a corrected version of the printed article. This page is a summary prepared by Medpresso from the original publication and is not a substitute for the full text or for medical advice.