Treatment

There is no specific treatment for the common cold.

Measures which may be considered and are likely to be beneficial include (1):

• decongestants - compared with placebo, decongestants (norephedrine, oxymetazoline, or pseudoephedrine) reduced nasal congestion over 3-10 hours after a single dose in people with common cold
  • single doses of oral or topical decongestants (norephedrine, pseudoephedrine, phenylpropanolamine) have been shown to give moderate, short-term relief of nasal congestion in adults with a common cold
    • however, there is no evidence to support regular use, and prolonged use of topical decongestants can cause rebound congestion on withdrawal (2)
• antihistamines - a systematic review found that chlorpheniramine or doxylaminine reduced runny nose and sneezing after 2 days compared with placebo in people with common cold, but the clinical benefit was small
  • antihistamines may reduce runny nose and sneezing
• analgesics or anti-inflammatory drugs are appropriate to relieve pain or fever (2)

Unknown effectiveness include (1):

• vitamin C Zinc (intranasal gel or lozenges)
• echinacea
• steam inhalation
• decongestants - insufficient evidence to assess longer term [> 10 hours] effects on congestive symptoms

Likely to be ineffective or harmful

• antibiotics
  • there is no evidence that antibiotics reduce the likelihood of secondary bacterial infection nor reduce coryzal symptoms
  • a systematic review concluded (2,3):
    • there is insufficient evidence of benefit to warrant the use of antibiotics for upper respiratory tract infections in children or adults. Antibiotics cause significant adverse effects in adults. The evidence on acute purulent rhinitis and acute clear rhinitis suggests a benefit for antibiotics for these conditions but their routine use is not recommended
    • with respect to acute purulent rhinitis, there is some evidence that antibiotics may resolve acute purulent rhinitis slightly faster than placebo
      • however antibiotic treatment has not been shown to improve other cold symptoms (e.g. pain, nasal congestion, sneezing) and patients may suffer adverse effects
      • as most patients will get better without antibiotics, antibiotics should only be used in purulent rhinitis when symptoms have persisted for long enough to cause concern (2)

With respect to treatments for cough and common cold in children and review noted that:

• safe treatments for bothersome symptoms include saline nasal irrigation, pasteurised honey for cough, and analgesics, but most symptoms require no interventions (4)

Note that prolonged use of nasal nasal decongestants may predispose to rhinitis medicamentosa

Reference:

1. Clinical Evidence Update (December 2004)
2. MeReC Bulletin 2006. Common Cold. 17:3.
3. Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Coochrane Database Syst Rev 2005; (3): CD000247
4. Gill P J, Onakpoya I J, Buchanan F, Birnie K A, Van den Bruel A. Treatments for cough and common cold in childrenBMJ 2024; 384 :e075306