Treatment of the Common Cold

 

Am Fam Physician. 2019 Sep 1;100(5):281-289.

  Patient information: See related handouts on treating common colds in adults and treating common colds in children, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Acute upper respiratory tract infections are extremely common in adults and children, but only a few safe and effective treatments are available. Patients typically present with nasal congestion, rhinorrhea, sore throat, cough, general malaise, and/or low-grade fever. Informing patients about the self-limited nature of the common cold can help manage expectations, limit antibiotic use, and avoid over-the-counter purchases that may not help. Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough. Lower-quality evidence suggests that Lactobacillus casei may be beneficial in older adults. The only established safe and effective treatments for children are acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils. Over-the-counter cold medications should not be used in children younger than four years. Counseling patients about the importance of good hand hygiene is the best way to prevent transmission of cold viruses.

Acute upper respiratory tract infection (URI), also called the common cold, is the most common acute illness in the United States and the industrialized world.1 Patients typically present with nasal congestion, rhinorrhea, sore throat, cough, general malaise, and/or low-grade fever. Symptoms are self-limited, often lasting up to 10 days. In children, the median duration is eight days in those who receive medical care, and 90% of cases resolve within 23 days.2 Viruses such as rhinovirus are the predominant cause of acute URI; transmission occurs through contact with the nasal secretions and saliva of infected people.3 The common cold should be distinguished from allergic rhinitis, isolated pharyngitis, acute bronchitis (which generally has a longer duration, with a mean of 18 days in adults and 12 days in children2,4 ), influenza, bacterial sinusitis, and pertussis (Table 1). The primary goals of treatment are reduction of symptom duration and severity. Over-the-counter cold medications should not be used to treat children younger than four years because of lack of benefit and low but significant mortality rates associated with their use in this population.5,6 Informing patients about the natural course of the common cold can help manage expectations, limit antibiotic use,7  and avoid unnecessary over-the-counter purchases (Table 2).

 Enlarge     Print

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Over-the-counter cold medications should not be used in children younger than four years because of potential harms and lack of benefit.5,6

B

Lack of benefit in 10 RCTs in children and observational studies of adverse effects

The use of hand sanitizer or hand washing is the most effective way to prevent the common cold.8,9

B

Systematic review of cluster RCTs and observational studies with variable risk of bias

Treatments with established effectiveness for cold symptoms in adults are limited to over-the-counter analgesics and decongestants with or without antihistamines (but not antihistamine monotherapy).6,22,25,27,31

B

Systematic reviews of RCTs of varying quality

Antibiotics are ineffective for treatment of the common cold in adults and children and should not be prescribed.46,47

A

Consistent findings of no benefit and increased adverse effects in systematic reviews of 11 RCTs

Codeine and other antitussives have not been proven effective for cough in adults.6,48,54

B

Systematic reviews and a clinical practice guideline from the American College of Chest Physicians

Safe and effective treatments for cold symptoms in children include nasal saline irrigation, menthol rub, and honey (for children 12 months and older).39,61,63,65

B

Systematic reviews of RCTs of varying quality


RCT = randomized controlled trial.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Over-the-counter cold medications should not be used in children younger than four years because of potential harms and lack of benefit.5,6

B

Lack of benefit in 10 RCTs in children and observational studies of adverse effects

The use of hand sanitizer or hand washing is the most effective way to prevent the common cold.8,9

B

Systematic review of cluster RCTs and observational studies with variable risk of bias

Treatments with established effectiveness for cold symptoms in adults are limited to over-the-counter analgesics and decongestants with or without antihistamines

The Authors

show all author info

KATHARINE C. DEGEORGE, MD, MS, is an associate professor of family medicine, assistant director of the Family Medicine Residency Program, and associate director of the Faculty Development Fellowship at the University of Virginia Department of Family Medicine, Charlottesville....

DANIEL J. RING, MD, is a third-year family medicine resident at the University of Virginia Department of Family Medicine.

SARAH N. DALRYMPLE, MD, is an assistant professor of family medicine at the University of Virginia Department of Family Medicine.

Address correspondence to Katharine C. DeGeorge, MD, MS, University of Virginia School of Medicine, Box 800729, Charlottesville, VA 22908 (email: kd6fp@virginia.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Centers for Disease Control and Prevention. National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1996. Accessed July 17, 2019. https://www.cdc.gov/nchs/data/series/sr_10/sr10_200.pdf...

2. Hay AD, Anderson E, Ingle S, et al. Respiratory tract infections in children in the community: prospective online inception cohort study. Ann Fam Med. 2019;17(1):14–22.

3. Kirkpatrick GL. The common cold. Prim Care. 1996;23(4):657–675.

4. Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5–13.

5. U.S. Food Drug Administration. Use caution when giving cough and cold products to kids. Accessed November 21, 2018. https://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm263948.htm

6. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014;(11):CD001831.

7. Centers for Disease Control and Prevention. Antibiotic use in the United States, 2017: progress and opportunities. Accessed June 19, 2019. https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report.pdf

8. Jefferson T, Del Mar CB, Dooley L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2011;(7):CD006207.

9. Hübner NO, Hübner C, Wodny M, et al. Effectiveness of alcohol-based hand disinfectants in a public administration: impact on health and work performance related to acute respiratory symptoms and diarrhoea. BMC Infect Dis. 2010;10:250.

10. Dyer DL, Shinder A, Shinder F. Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism. Fam Med. 2000;32(9):633–638.

11. Chamberlain AN, Halablab MA, Gould DJ, et al. Distribution of bacteria on hands and the effectiveness of brief and thorough decontamination procedures using non-medicated soap. Zentralbl Bakteriol. 1997;285(4):565–575.

12. Todd EC, Michaels BS, Smith D, et al. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 9. Washing and drying of hands to reduce microbial contamination. J Food Prot. 2010;73(10):1937–1955.

13. Aiello AE, Coulborn RM, Perez V, et al. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372–1381.

14. Seida JK, Durec T, Kuhle S. North American (Panax quinquefolius) and Asian ginseng (Panax ginseng) preparations for prevention of the common cold in healthy adults: a systematic review. Evid Based Complement Alternat Med. 2011;2011:282151.

15. Simancas-Racines D, Franco JV, Guerra CV, et al. Vaccines for the common cold. Cochrane Database Syst Rev. 2017;(5):CD002190.

16. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013;(1):CD000980.

17. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.

18. Aglipay M, Birken CS, Parkin PC, et al.; TARGet Kids! Collaboration. Effect of high-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. JAMA. 2017;318(3):245–254.

19. Murdoch DR, Slow S, Chambers ST, et al. Effect of vitamin D3 supplementation on upper respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial. JAMA. 2012;308(13):1333–1339.

20. Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;(2):CD006895.

21. Satomura K, Kitamura T, Kawamura T, et al.; Great Cold Investigators-I. Prevention of upper respiratory tract infections by gargling: a randomized trial. Am J Prev Med. 2005;29(4):302–307.

22. Li S, Yue J, Dong BR, et al. Acetaminophen (paracetamol) for the common cold in adults. Cochrane Database Syst Rev. 2013;(7):CD008800.

23. De Sutter AI, van Driel ML, Kumar AA, et al. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev. 2012;(2):CD004976.

24. Holmes PW, Barter CE, Pierce RJ. Chronic persistent cough: use of ipratropium bromide in undiagnosed cases following upper respiratory tract infection. Respir Med. 1992;86(5):425–429.

25. Deckx L, De Sutter AI, Guo L, et al. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016;(10):CD009612.

26. Guillemard E, Tondu F, Lacoin F, et al. Consumption of a fermented dairy product containing the probiotic Lactobacillus casei DN-114001 reduces the duration of respiratory infections in the elderly in a randomised controlled trial. Br J Nutr. 2010;103(1):58–68.

27. Kim SY, Chang YJ, Cho HM, et al. Non-steroidal anti-inflammatory drugs for the common cold. Cochrane Database Syst Rev. 2015;(9):CD006362.

28. Hemilä H, Chalker E. The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: a meta-analysis. BMC Fam Pract. 2015;16:24.

29. Hemilä H. Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. JRSM Open. 2017;8(5):2054270417694291.

30. Science M, Johnstone J, Roth DE, et al. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2012;184(10):E551–E561.

31. Little P, Moore M, Kelly J, et al.; PIPS Investigators. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ. 2013;347:f6041.

32. Reinecke S, Tschaikin M. Investigation of the effect of oxymetazoline on the duration of rhinitis. results of a placebo-controlled double-blind study in patients with acute rhinitis [in German]. MMW Fortschr Med. 2005;147(suppl 3):113–118.

33. Dykewicz MS, Fineman S, Skoner DP, et al.; American Academy of Allergy, Asthma, and Immunology. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81(5 pt 2):478–518.

34. DeSutter AI, Saraswat A, van Driel ML. Antihistamines for the common cold. Cochrane Database Syst Rev. 2015;(11):CD009345.

35. Klimek L, Schumacher H, Schütt T, et al. Factors associated with efficacy of an ibuprofen/pseudoephedrine combination drug in pharmacy customers with common cold symptoms. Int J Clin Pract. 2017;71(2):e12907.

36. Bolser DC. Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):238S–249S.

37. Zanasi A, Lecchi M, Del Forno M, et al. A randomized, placebo-controlled, double-blind trial on the management of post-infective cough by inhaled ipratropium and salbutamol administered in combination. Pulm Pharmacol Ther. 2014;29(2):224–232.

38. Prasad AS, Fitzgerald JT, Bao B, et al. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245–252.

39. King D, Mitchell B, Williams CP, et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;(4):CD006821.

40. Guppy MP, Mickan SM, Del Mar CB, et al. Advising patients to increase fluid intake for treating acute respiratory infections. Cochrane Database Syst Rev. 2011;(2):CD004419.

41. Chalumeau M, Duijvestijn YC. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst Rev. 2013;(5):CD003124.

42. Josling P. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Adv Ther. 2001;18(4):189–193.

43. Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database Syst Rev. 2014;(11):CD006206.

44. Li G, Cai L, Jiang H, et al. Compound formulas of traditional Chinese medicine for the common cold: systematic review of randomized, placebo-controlled trials. Altern Ther Health Med. 2015;21(6):48–57.

45. Zhang X, Wu T, Zhang J, et al. Chinese medicinal herbs for the common cold. Cochrane Database Syst Rev. 2007;(1):CD004782.

46. Spurling GK, Del Mar CB, Dooley L, et al. Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 2017;(9):CD004417.

47. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013;(6):CD000247.

48. Freestone C, Eccles R. Assessment of the antitussive efficacy of codeine in cough associated with common cold. J Pharm Pharmacol. 1997;49(10):1045–1049.

49. Karsch-Völk M, Barrett B, Kiefer D, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;(2):CD000530.

50. Hayward G, Thompson MJ, Perera R, et al. Corticosteroids for the common cold. Cochrane Database Syst Rev. 2015;(10):CD008116.

51. Timmer A, Günther J, Motschall E, et al. Pelargonium sidoides extract for treating acute respiratory tract infections. Cochrane Database Syst Rev. 2013;(10):CD006323.

52. Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002;137(12):939–946.

53. Graat JM, Schouten EG, Kok FJ. Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial. JAMA. 2002;288(6):715–721.

54. Malesker MA, Callahan-Lyon P, Ireland B, et al.; CHEST Expert Cough Panel. Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold. Chest. 2017;152(5):1021–1037.

55. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315(17):1864–1873.

56. Singh M, Singh M, Jaiswal N, et al. Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2017;(8):CD001728.

57. Woelkart K, Linde K, Bauer R. Echinacea for preventing and treating the common cold. Planta Med. 2008;74(6):633–637.

58. Yale SH, Liu K. Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med. 2004;164(11):1237–1241.

59. Wong T, Stang AS, Ganshorn H, et al. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database Syst Rev. 2013;(10):CD009572.

60. Paul IM, Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140–1146.

61. Oduwole O, Udoh EE, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane Database Syst Rev. 2018;(4):CD007094.

62. AlBalawi ZH, Othman SS, Alfaleh K. Intranasal ipratropium bromide for the common cold. Cochrane Database Syst Rev. 2013;(6):CD008231.

63. Slapak I, Skoupá J, Strnad P, et al. Efficacy of isotonic nasal wash (sea-water) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008;134(1):67–74.

64. Paul IM, Beiler JS, King TS, et al. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics. 2010;126(6):1092–1099.

65. Kenia P, Houghton T, Beardsmore C. Does inhaling menthol affect nasal patency or cough? Pediatr Pulmonol. 2008;43(6):532–537.

66. Eby GA, Davis DR, Halcomb WW. Reduction in duration of common colds by zinc gluconate lozenges in a double-blind study. Antimicrob Agents Chemother. 1984;25(1):20–24.

67. Macknin ML, Piedmonte M, Calendine C, et al. Zinc gluconate lozenges for treating the common cold in children: a randomized controlled trial. JAMA. 1998;279(24):1962–1967.

68. Singh M, Das RR. Withdrawn: zinc for the common cold. Cochrane Database Syst Rev. 2015;(4):CD001364.

69. McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database Syst Rev. 2000;(2):CD001107.

70. Taylor JA, Novack AH, Almquist JR, et al. Efficacy of cough suppressants in children. J Pediatr. 1993;122(5 pt 1):799–802.

71. Paul IM, Yoder KE, Crowell KR, et al. Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114(1):e85–e90.

72. Bernard DW, Goepp JG, Duggan AK, et al. Is oral albuterol effective for acute cough in non-asthmatic children? Acta Paediatr. 1999;88(4):465–467.

73. Becker LA, Hom J, Villasis-Keever M, et al. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Cochrane Database Syst Rev. 2015;(9):CD001726.

74. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290(21):2824–2830.

75. Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. Am Fam Physician. 2012;86(2):153–159. Accessed June 19, 2019. https://www.aafp.org/afp/2012/0715/p153.html

76. Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007;75(4):515–520. Accessed June 19, 2019. https://www.aafp.org/afp/2007/0215/p515.html

 

 

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article