Treatment of the Common Cold

Katharine C. DeGeorge; Daniel J. Ring; Sarah N. Dalrymple

Sep 1, 2019 Issue

Treatment of the Common Cold

KATHARINE C. DEGEORGE, MD, MS; DANIEL J. RING, MD; and SARAH N. DALRYMPLE, MD, University of Virginia Department of Family Medicine, Charlottesville, Virginia

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).

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	Comments
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 recommendation	Evidence rating	Comments
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

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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.

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