Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
Reassure patients about the self-limiting nature of the condition, and that symptoms usually clear within 7 to 10 days.
Advise patients about hygiene measures and limiting the spread to others, as well as the importance of rest and maintaining fluid intake to stay hydrated. The implications of increased fluid intake in acute respiratory infections have not been studied in any trials to date.[34]
Antibiotics are not recommended for the common cold.[1][56][58] A delayed prescription for antibiotics, alongside advice on the natural history of the illness and symptomatic treatments, has been found to reduce the rate of antibiotic use (31%) compared with immediate antibiotics (93%) with similar rates of patient satisfaction.[59] Providing written information about the use of antibiotics to parents of children with upper respiratory tract infections can also reduce the number of antibiotics used without affecting parental satisfaction.[60]
Treatment recommended for SOME patients in selected patient group
Primary options
acetaminophen: children: 15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day
OR
ibuprofen: children: 5-10 mg/kg orally every 4-6 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day
OR
naproxen: adults: 250-500 mg orally twice daily when required, maximum 1250 mg/day
OR
aspirin: adults: 325-650 mg orally every 4 hours when required, maximum 4000 mg/day
Acetaminophen is recommended for pain and/or fever. Evidence suggests that it may also help with nasal congestion and rhinorrhea, but not sore throat, malaise, sneezing, or cough.[36] Despite this, it is still one of the most widely used analgesic/antipyretic agents, and is a first choice for many clinicians for the management of pain and fever in both adults and children.[37]
A review of nonsteroidal anti-inflammatory drugs (NSAIDs) found benefit for reducing discomfort, but found no benefit in terms of easing respiratory symptoms. Possible adverse effects need to be considered (e.g., gastrointestinal adverse effects, rash).[38]
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Studies of aspirin have found it to be effective for pain and fever, without serious gastrointestinal adverse effects with short-term use,[39] although a small increased risk of dyspepsia has been reported.[40] Aspirin should be avoided in children and adolescents under 18 years of age because of the risk of Reye syndrome.
Treatment recommended for SOME patients in selected patient group
Primary options
oxymetazoline nasal: (0.05%) children ≥6 years of age and adults: 1-2 drops/sprays in each nostril two to four times daily when required
OR
ipratropium bromide nasal: (0.06%) children 6-11 years of age: 2 sprays in each nostril three times daily when required; children ≥12 years of age and adults: 2 sprays in each nostril three to four times daily when required
OR
cetirizine/pseudoephedrine: children ≥12 years of age and adults: 5 mg/120 mg (1 tablet) orally (extended-release) twice daily when required
There are many formulations available aimed at treating rhinorrhea, nasal congestion, or sneezing, including single-agent and combination formulations. Decongestants are available as oral or intranasal formulations. A few examples are provided; however, this list is not exhaustive and a local formulary should be consulted.
Decongestants and/or antihistamines are the best option for adults with bothersome nasal symptoms; however, the effect is considered small, and use should be limited to 3 to 7 days.[35]
Decongestants and/or antihistamines are not recommended in children <6 years of age, and caution is recommended in children ages 6 to 12 years. There is no evidence that they alleviate nasal symptoms in children, and they are known to cause adverse effects (e.g., drowsiness, gastrointestinal upset, more serious harms such as convulsions and rapid heart rate, and death). There is low-quality evidence that saline drops or sprays may be safe and effective in young children.[35]
The Food and Drug Administration does not recommend cold products in children under 4 years of age.[47] In the UK and Canada, cold products are not recommended in children under 6 years of age. FDA: use caution when giving cough and cold products to kids external link opens in a new window
Intranasal decongestants should be used for a maximum of 3 to 7 days due to the risk of chronic/rebound nasal congestion (rhinitis medicamentosa).
Ipratropium nasal spray is an effective treatment for rhinorrhea, but not for nasal congestion. Adverse effects (e.g., dry mouth, nose bleeds, nasal dryness) were more frequent compared with placebo or no treatment.[46]
Treatment recommended for SOME patients in selected patient group
There is no evidence to support or refute the use of over-the-counter antitussive agents, expectorants, mucolytic agents, or antihistamines (including combinations of these agents) to reduce the incidence of cough in adults or children, particularly young children.[50][51] The American College of Chest Physicians recommends against the use of over-the-counter cough and cold medicines for the treatment of cough.[52][Evidence C]
Cough and cold medications that include opioids, such as codeine or hydrocodone, should not be used in children aged 18 years or younger as the risks (slowed or difficult breathing, misuse, abuse, addiction, overdose, and death) outweigh the benefits when used for cough in these patients.[53]
Honey has been shown to offer more relief of cough symptoms compared to no treatment, placebo, and diphenhydramine in children aged 1 to 18 years, but is not better than dextromethorphan.[54][52][Evidence C]
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