Common cold

Last reviewed: 4 Jan 2023

Last updated: 29 Mar 2022

Most people experience at least one common cold per year; these are usually self-limiting and resolve within a few days.

Diagnosis is generally clinical, based on history and examination. Investigations may be required when symptoms worsen or do not resolve in the usual timeframe.

Treatment includes reassurance that this is a self-limiting condition, rest, adequate fluid intake, and an analgesic/antipyretic for pain/fever. Antibiotics are not recommended.

Decongestants and/or antihistamines may have a role in reducing nasal symptoms in adults; however, the evidence is limited, and these treatments are generally not recommended in young children. Antitussives may be used for cough; however, there is no evidence to support or refute their use, and opioids are not recommended for this indication in children and adolescents under 18 years of age.

Complications include bacterial infections such as otitis media, sinusitis, or pneumonia.

Definition

An acute, self-limiting inflammation of the upper respiratory tract mucosa that may involve any or all of the nose, throat, sinuses, and larynx. The condition is not characterised by a discrete set of specific symptoms, with the illness varying according to individual and causative pathogen. Occasionally, there is spread to the lower respiratory tract. Symptoms include sore throat, sneezing, blocked, and/or runny nose, headache, cough, malaise, and low-grade fever. The condition is associated with more than 200 virus subtypes.

History and exam

Key diagnostic factors

presence of risk factors
acute onset
rhinitis
sore throat
sneezing
post-nasal drainage/drip
cough
fever
non-specific red pharynx
nasal mucosal oedema/erythema
purulent drainage in nares and posterior pharynx
pulse <100 bpm; no hypotension

More key diagnostic factors

Other diagnostic factors

malaise
myalgia
halitosis
inflamed tonsils

Other diagnostic factors

Risk factors

exposure to affected individuals
young age
winter season
day care attendance
exposure to cigarette smoke or other respiratory irritants

More risk factors

Diagnostic investigations

1st investigations to order

no initial test

More 1st investigations to order

Investigations to consider

FBC
throat swab
sputum culture
heterophile antibody test
C-reactive protein (CRP)
chest x-ray
sinus CT scan
viral testing

More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Bruce Arroll, MBChB, PhD, FRNZCGP

Professor

Department of General Practice and Primary Health Care

University of Auckland

Auckland

New Zealand

Disclosures

BA is an author of a number of references cited in this topic.

Timothy Kenealy, MBChB, PhD, FRNZCGP

Associate Professor of Integrated Care

Department of General Practice and Primary Health Care

University of Auckland

Auckland

New Zealand

Disclosures

TK is an author of a number of references cited in this topic.

Peer reviewers

Christopher Cates, MA, FRCGP

Senior Research Fellow

Division of Community Health Sciences

St. George's University of London

London

Disclosures

CC declares that he has no competing interests.

Christopher Del Mar, MA MB, BChir MD, FRACGP, FAFPHM

Professor

Faculty of Health Sciences and Medicine

Bond University

Queensland

Australia

Disclosures

CDM declares that he has no competing interests.

An De Sutter, MD, PhD

Associate Professor

Department of General Practice and Primary Health Care

Ghent University

Belgium

Disclosures

ADS declares that she has no competing interests.

Greg Poland, FRCOG

Mary Lowell Leary Endowed Professor

General Internal Medicine

Paediatrics

Mayo Clinic

Rochester

Disclosures

GP has no competing interests in regards to the common cold. He does consult with a variety of manufacturers and performs research studies related to influenza, founded by vaccine manufacturers, none of which involves virus related to the common cold.

Peter Dicpinigaitis, MD

Professor of Clinical Medicine

Albert Einstein College of Medicine

Director

Intensive Care Unit

Weiler Division/Montefiore Medical Center

Bronx

Disclosures

PD has served as a consultant to Reckitt Benckiser, Procter & Gamble, Wyeth Pharmaceuticals, Novartis, Glaxo SmithKline, and Boehringer Ingelheim.

Differentials
- Coronavirus disease 2019 (COVID-19)
- Hay fever (allergic rhinitis)
- Chronic sinusitis
More Differentials
Guidelines
- Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST expert panel report
- Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention
More Guidelines
Patient leaflets
Common cold
Treating coughs and colds in children
More Patient leaflets
Calculators
Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)
More Calculators
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Common cold

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Bruce Arroll, MBChB, PhD, FRNZCGP

Disclosures

Timothy Kenealy, MBChB, PhD, FRNZCGP

Disclosures

Peer reviewers

Christopher Cates, MA, FRCGP

Disclosures

Christopher Del Mar, MA MB, BChir MD, FRACGP, FAFPHM

Disclosures

An De Sutter, MD, PhD

Disclosures

Greg Poland, FRCOG

Disclosures

Peter Dicpinigaitis, MD

Disclosures

Differentials

Guidelines

Patient leaflets

Calculators

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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