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

Acute upper respiratory tract infections are extremely common in adults and children, but only a few safe and effective treat-
ments 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 decon-
gestants 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,

Illustration by Jonathan Dimes

honey (for children one year and older), nasal saline irrigation, intranasal ipra-
tropium, and topical application of ointment containing camphor, menthol, and
eucalyptus oils. Over-the-counter cold medications should not be used in chil-
dren younger than four years. Counseling patients about the importance of good
hand hygiene is the best way to prevent transmission of cold viruses. (Am Fam
Physician. 2019;​​100(5):​​281-289. Copyright © 2019 American Academy of Family Physicians.)

Acute upper respiratory tract infection (URI), also reduction of symptom duration and severity. Over-the-
called the common cold, is the most common acute illness counter cold medications should not be used to treat chil-
in the United States and the industrialized world.1 Patients dren younger than four years because of lack of benefit and
typically present with nasal congestion, rhinorrhea, sore low but significant mortality rates associated with their use
throat, cough, general malaise, and/or low-grade fever. in this population.5,6 Informing patients about the natural
Symptoms are self-limited, often lasting up to 10 days. In course of the common cold can help manage expectations,
children, the median duration is eight days in those who limit antibiotic use,7 and avoid unnecessary over-the-
receive medical care, and 90% of cases resolve within counter purchases (Table 2).
23 days.2 Viruses such as rhinovirus are the predominant
cause of acute URI;​​transmission occurs through contact
BEST PRACTICES IN INFECTIOUS DISEASES
with the nasal secretions and saliva of infected people.3 The
common cold should be distinguished from allergic rhini-
tis, isolated pharyngitis, acute bronchitis (which generally Recommendations from the Choosing
has a longer duration, with a mean of 18 days in adults Wisely Campaign
and 12 days in children2,4), influenza, bacterial sinusitis, Recommendation Sponsoring organization
and pertussis (Table 1). The primary goals of treatment are
Antibiotics should not be used for American Academy
apparent viral respiratory illnesses of Pediatrics
(sinusitis, pharyngitis, bronchitis).
CME This clinical content conforms to AAFP criteria for con-
tinuing medical education (CME). See CME Quiz on page 271. Avoid prescribing antibiotics for Infectious Diseases
upper respiratory infections. Society of America
Author disclosure:​​​ No relevant financial affiliations.
Patient information:​​ Handouts on this topic, written by the Source:​​ For more information on the Choosing Wisely Campaign,
authors of this article, are available at [Link] [Link]/ see [Link] [Link]. For supporting citations and
afp/2019/0901/[Link] and [Link] [Link]/ to search Choosing Wisely recommendations relevant to primary
afp/2019/0901/[Link]. care, see [Link] [Link]/afp/recommendations/[Link].

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 COMMON COLD

SORT:​​KEY RECOMMENDATIONS FOR PRACTICE

Evidence
Clinical recommendation rating Comments

Over-the-counter cold medications should not be used in children B Lack of benefit in 10 RCTs in children and
younger than four years because of potential harms and lack of observational studies of adverse effects
benefit. 5,6

The use of hand sanitizer or hand washing is the most effective way B Systematic review of cluster RCTs and observa-
to prevent the common cold.8,9 tional studies with variable risk of bias

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

Antibiotics are ineffective for treatment of the common cold in adults A Consistent findings of no benefit and increased
and children and should not be prescribed.46,47 adverse effects in systematic reviews of 11 RCTs

Codeine and other antitussives have not been proven effective for B Systematic reviews and a clinical practice
cough in adults.6,48,54 guideline from the American College of Chest
Physicians

Safe and effective treatments for cold symptoms in children include B Systematic reviews of RCTs of varying quality
nasal saline irrigation, menthol rub, and honey (for children 12
months and older). 39,61,63,65

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 [Link] [Link]/afpsort.

TABLE 1

Differential Diagnosis for the Common Cold

Symptom
Diagnosis onset Cough Sore throat Fever Rhinorrhea Aches Watery eyes

Acute Gradual Prominent, per- Common None or low Uncommon Mild Common
bronchitis sistent, dry or wet grade

Allergic Gradual Common, chronic Possible, especially None Common, None Common
rhinitis on awakening prominent

Bacterial Gradual Common Common Common Common Common Uncommon

sinusitis

Common Gradual Common, dry Common None or low Common Mild Common
cold grade

Influenza Abrupt Common, dry Common Characteristic;​​ Common Early, Uncommon

hacking high and rises prominent
rapidly

Pertussis Gradual Prominent, parox- Uncommon None or low Uncommon Uncommon Uncommon
ysmal, whoop-like grade

Pharyngitis Gradual Uncommon Characteristic;​​ Variable (low Common Can be Common

prominent grade if viral, severe
high if bacterial) if bacterial

282 American Family Physician [Link]/afp Volume 100, Number 5 ◆ September 1, 2019
 TABLE 2

Managing Discussions with Patients About Unneces-

sary Antibiotics
Step Examples Prevention
Explain why “The common cold is caused by a virus, so antibiot- Good hand hygiene is the most effective and
antibiotics will ics won’t help.” practical way to prevent URIs in children and
not help “Antibiotics can’t fight viruses like colds. Taking them adults.8 The use of hand sanitizer is more pro-
won’t do any good this time and may hurt their tective than hand washing and is associated with
chances of fighting bacterial infections you might shorter duration of symptoms and fewer school
get in the future.”
absences.9,10 Washing hands several times per
Suggest treat- “You can try honey for your cough, ibuprofen or day for at least 15 to 30 seconds can help prevent
ments that might acetaminophen for your muscle aches, and nasal or illness.8,11,12 Regular soap is as effective as anti-
help oral decongestants with or without an antihistamine bacterial soap.13
for your congestion.”
Interventions with limited or no effectiveness
Manage expec- “Cold viruses can make you feel lousy. Most people for the prevention of the common cold include
tations for length start to feel better after about a week, but some- ginseng and echinacea,14 adenovirus vaccina-
of illness times the cough can last even longer, especially if tion,15 vitamin C or D,16-19 probiotics,20 and water
you smoke.”
gargles.21
“It is common for children and adults (especially
those around young children) to seem sick through-
out the entire fall and winter. You can catch one cold
Treatment for Adults
virus right after another, like planes taking off at a EFFECTIVE SYMPTOMATIC TREATMENTS
busy airport. The good news is that you should not Effective treatments for symptoms of the com-
get those same viruses again.”
mon cold in adults are limited to intranasal ipra-
Discuss next “If you develop worsening symptoms like a fever tropium (Atrovent), over-the-counter analgesics,
steps if patient higher than 101°F (38.3°C), productive cough, short- decongestants with or without antihistamines,
does not improve ness of breath, or very bad headache or facial pain, and zinc (Table 3).22-30
call my office so we can make sure you don’t have a
Analgesics. Nonsteroidal anti-inflammatory
more serious illness.”
drugs—mainly ibuprofen—have been shown to
reduce headache, ear pain, muscle pain, joint
pain, and sneezing but do not improve cough, cold duration,
or total symptom score.27 Ibuprofen is more effective than
acetaminophen for reducing fever-related discomfort.31
Acetaminophen may provide short-term relief of rhinor-
rhea and nasal obstruction but has no effect on sore throat,
Nasal Shortness malaise, sneezing, or cough.22
Sneezing congestion Headache of breath Decongestants. Nasal decongestants (oral and intrana-
Uncommon Uncommon Common, mild Common sal) may relieve nasal congestion,25 but there is no evidence
that they reduce cough. Topical oxymetazoline, which is
included in many over-the-counter intranasal deconges-
Prominent Common Uncommon Uncommon
tants, reduces the duration and severity of nasal congestion
after multiple doses.32 Patients should be warned about the
Uncommon Common Common Uncommon risk of rhinitis when intranasal oxymetazoline is used for
more than three days.33
Common Common Common, mild Uncommon Antihistamines in Combination Medications. Antihista-
mines combined with oral decongestants and/or analge-
Uncommon Possible Prominent Uncommon sics may provide some relief of cold symptoms, although
the effect on cough is limited.6,23 This benefit is most pro-
nounced in the first two days of treatment.34 When started
Uncommon Uncommon Uncommon Common on the first day of symptoms, medications containing ibu-
profen and pseudoephedrine may reduce the severity of cold
Common Uncommon Common;​​ mild Uncommon
symptoms.35 Antihistamine monotherapy is not effective
if viral if viral, severe for relieving cough.6,23
if bacterial Ipratropium. Intranasal ipratropium is the only med-
ication that improves persistent cough related to URI in

September 1, 2019 ◆ Volume 100, Number 5 [Link]/afp American Family Physician 283
 COMMON COLD
TABLE 3

Effective Treatments for Cold Symptoms in Adults

Treatment Dosing Duration of treatment Study findings

Acetaminophen 500 to 1,000 mg Single dose Cochrane review without data pooling of 4 low- to moderate-
quality trials with outcome assessment at 3 to 6 hours found
improvement in nasal obstruction and rhinorrhea but not in
other symptoms;​​no numeric data provided 22

Antihistamine plus Varies Variable Cochrane review of 12 trials, including 6 placebo controlled
decongestant with pooled data, found odds ratio of treatment failure = 0.27
(95% CI, 0.15 to 0.50);​​number needed to treat = 4, but 41%
favorable response in placebo group 23

Intranasal ipratro- 4 20-g puffs 4 times 3 weeks One small, randomized, double-blind crossover trial (N = 14)
pium (Atrovent) per day found significant reduction in persistent cough 24

Intranasal 2 sprays (0.05%) per Up to 10 days Cochrane review of 15 trials (N = 1,838) found no improvement
oxymetazoline nostril 1 or 2 times in nasal congestion with single use, but small improvement vs.
per day placebo after multiple doses (SMD = 0.49;​​95% CI, 0.07 to 0.92)25

Lactobacillus 200 g per day of fer- 3 months RCT of 1,072 older adults found significant improvement in
casei (for older mented dairy product duration of colds and in cumulative days with colds when
adults) containing L. casei taken daily  26

Nonsteroidal Varies Varies from single Cochrane review of 9 moderate-quality RCTs (N = 1,069) found
anti-inflammatory dose to 7 days no effect on total symptom score or cough, but improved
drugs sneezing (SMD = −0.44;​​95% CI, −0.75 to −0.12), headache
(SMD = –0.65;​​95% CI, –1.11 to –0.19), and ear, muscle, and
joint pain (SMD = –0.40;​​95% CI, –0.77 to –0.03) vs. placebo 27

Zinc acetate or Varies;​​typically 80 to Start within 3 days of 3 systematic reviews and meta-analyses found similar
gluconate 92 mg per day symptom onset and improvement in symptom duration (by about one-third) and
continue as long as mixed conclusions on symptom severity  28-30
symptoms persist

RCT = randomized controlled trial;​​SMD = standardized mean difference.

Information from references 22-30.

adults.24,36 Inhaled ipratropium in combination with salbu- hyponatremia.40 Good evidence is similarly lacking for ace-
tamol (a short-acting beta agonist that is not available in tylcysteine,41 garlic,42,43 and Chinese medicinal herbs.44,45
the United States) improves cough during the first 10 days
of treatment, but there is no benefit at 20 days compared INEFFECTIVE TREATMENTS
with placebo.37 There are more ineffective treatments for the common cold
Complementary and Alternative Treatments. Several than effective treatments, and some may even be harmful
meta-analyses and a randomized controlled trial suggest (Table 4).6,16,19,34,46-54 Treatments that are not recommended
that taking at least 75 mg of zinc acetate or gluconate loz- include antibiotics, antivirals, most cough medications, anti-
enges per day relieves cough and nasal discharge more histamine monotherapy, intranasal corticosteroids, steam,
quickly when treatment is started within 24 hours of symp- vitamins D and E, echinacea, and Pelargonium sidoides (Afri-
tom onset.28-30,38 Probiotics may have a role in the treatment can geranium).
of URIs. A randomized controlled trial showed that three Antibiotics. Antibiotics have no role in the treatment of the
months of daily use of a fermented dairy product contain- common cold. They do not reduce the severity or duration of
ing Lactobacillus casei reduced the duration of URI symp- symptoms, even when purulent rhinitis is present.46,47 Anti-
toms by 1.5 days in older adults.26 biotic prescriptions for patients with URI are a major source
of inappropriate prescribing in the outpatient setting.55
TREATMENTS WITH UNCERTAIN BENEFIT Informing patients about the natural course of URIs and rec-
Although nasal saline irrigation is effective for the treat- ommending appropriate treatments will improve antibiotic
ment of chronic rhinosinusitis, only low-quality evidence stewardship in the United States.7
supports its benefit in URIs.39 Increased fluid intake is Antihistamine Monotherapy. When used alone, antihista-
commonly recommended, but low-quality data suggest mines are no more effective than placebo for the treatment of
that it may not provide benefit and in rare cases can cause cold symptoms.6,34

284 American Family Physician [Link]/afp Volume 100, Number 5 ◆ September 1, 2019
 COMMON COLD

Antitussives and Expectorants. Antitussives and expec- EFFECTIVE SYMPTOMATIC TREATMENTS

torants have little benefit in the treatment of cough due to Analgesics. Although ibuprofen and acetaminophen reduce
the common cold.6,54 Codeine and other opioid antitussives fever-related discomfort, ibuprofen may be more effec-
have not been studied extensively for the treatment of acute tive.59 Alternating these medications may reduce daycare
cough in adults.6 One trial of 82 adults found that codeine absences in children with fever.
was no more effective than placebo for
cough;​​however, both groups had sig-
nificant reductions in cough frequency TABLE 4
and severity during the first two days of
treatment.48 Ineffective Treatments for Cold Symptoms in Adults
Antivirals. Antivirals are not indi- Treatment Study type Findings
cated or effective for the treatment of Antibiotics 2 Cochrane reviews No benefit for symptom duration or
URIs, and they have been associated of 11 RCTs each 46,47 severity compared with no antibiotics or
with clinical syndromes similar to the placebo
common cold. Because of their effec- Antihistamine 2 Cochrane reviews No more effective than placebo for global
tiveness in preventing other conditions, monotherapy of 18 RCTs and a improvement
several antivirals (e.g., interferons, (sedating and subsequent RCT 6,34
dipyridamole [Persantine], palmitate) nonsedating)
have been studied for the treatment of Antitussives and Cochrane review No more effective than placebo for cough
URIs. However, no benefit was found, expectorants* of 10 trials without
and none are licensed for this use. meta-analysis 6
Intranasal Corticosteroids. Three Codeine Older RCT of 82 No more effective than placebo for cough
small trials found no evidence that adults 48
intranasal corticosteroids relieve symp- Echinacea Cochrane review No more effective than placebo for
toms of the common cold.50 of 24 RCTs without reducing symptom duration or severity
Complementary and Alterna- meta-analysis49
tive Treatments. Neither steam31,56
Intranasal Cochrane review of No more effective than placebo for
nor vitamin D supplementation19 corticosteroids 3 RCTs 50 reducing symptom duration or severity
improves symptoms of the common
Pelargonium Cochrane review of No significant improvement by day 5
cold. Once symptoms have developed,
sidoides (African a low-quality trial 51
vitamin C has no effect on symptom geranium)
duration or severity.16 Vitamin E can
Steam Cochrane review No benefit of using heated humidified air
actually make symptoms worse in
of 6 trials with 387 for treatment of URIs
older adults. Although echinacea was
53
participants 52
previously thought to provide benefit,
Vitamin C Cochrane review of No more effective than placebo for
high-quality studies have not shown
29 RCTs 16 reducing symptom duration or severity
that it reduces the duration or sever- once symptoms have developed
ity of cold symptoms.49,52,57,58 Based on
Vitamin D RCT of 322 adults 19
No difference in URI occurrence, days
low-quality evidence, P. sidoides does
of missed work, or symptom duration
not shorten time to resolution of cold or severity with high-dose vitamin D
symptoms in adults.51 supplementation (200,000 IU followed by
100,000 IU monthly)
Children Vitamin E RCT of 652 adults Significantly worse URI symptoms with
Safe and effective treatment options 60 years and older  53 daily supplementation of vitamin E
for symptoms of the common cold in (200 mg) compared with no supplemen-
tation;​​no difference in URI occurrence
children vary somewhat from those for
adults. Nasal saline irrigation, anal- RCT = randomized controlled trial;​​URI = upper respiratory tract infection.
gesics, and time are the mainstays of *—The American College of Chest Physicians does not recommend the use of antitussives or
treatment for URIs in children. Other expectorants. 54
effective treatments are summarized Information from references 6, 16, 19, 34, and 46-54.
in Table 5.6,16,41,59-64

September 1, 2019 ◆ Volume 100, Number 5 [Link]/afp American Family Physician 285
 COMMON COLD

Acetylcysteine. The mucolytic acetylcysteine may safely nasal congestion and reduce nighttime cough frequency
decrease cough after six to seven days in children two years and severity, improving sleep for both the child and par-
and older.41 ents.64 The use of menthol alone may also improve perceived
Ipratropium. Intranasal ipratropium may decrease rhi- nasal patency but may not help with cough.65 Menthol is
norrhea but not congestion related to URIs in children safe for use in children two years and older. The use of
five years and older. It should not be used in children honey before bedtime may also reduce the frequency and
younger than five years. The main adverse effects are nose- severity of cough.60,61 Honey should not be given to chil-
bleeds, nasal dryness, and headache, although these are dren younger than 12 months because of the risk of expo-
self-limited.62 sure to botulinum spores.
Nasal Saline Irrigation. One large trial found that chil-
dren who use saline nasal washes six times per day have TREATMENTS WITH UNCERTAIN BENEFIT
faster resolution of nasal secretions and nasal obstruction The use of antihistamines, either alone or in combination
and reduced use of antipyretics, decongestants, and antibi- with a decongestant, is no more effective than placebo,
otics.63 This regimen also reduces school absences. and the risk of harm is significant.6 There is insufficient
Complementary and Alternative Treatments. Application evidence on the use of oral or intranasal decongestants as
of ointment containing camphor, menthol, and eucalyptus monotherapy for symptoms of the common cold in chil-
oils on the chest and neck of children at bedtime can relieve dren.25 Guaifenesin and other expectorants have not been

TABLE 5

Effective Treatments for Cold Symptoms in Children

Age of Duration
Treatment participants Dosing of treatment Study findings

Acetylcysteine 0 to 18 years Varies Variable, up Cochrane review of 6 low- to moderate-quality trials (N =

to 28 days 497) found small reduction in cough at day 7 vs. placebo41

Analgesics 0 to 18 years Acetaminophen:​​ Variable Cochrane review of 6 low- to moderate-quality studies

15 mg per kg during (N = 915) found that acetaminophen and/or ibuprofen
Ibuprofen:​​ 5 to symptoms lowers temperature and may result in less discomfort  59
10 mg per kg

Honey 2 to 5 years 2.5 mL Once 2 Cochrane reviews and 1 RCT found significant reduction
6 to 11 years 5 mL Once in symptoms 6,60,61
12 to 18 years 10 mL Once

Intranasal 5 to 11 years 2 sprays (0.03% or First 2 to Cochrane review of 7 RCTs (N = 2,144) without meta-
ipratropium 0.6%) per nostril 3 3 days of analysis showed significant reduction in rhinorrhea but not
(Atrovent) or 4 times per day symptoms nasal congestion vs. placebo62

Nasal saline 6 to 10 years 3 to 9 mL per Up to RCT (N = 401) showed improved resolution of nasal
irrigation nostril 3 weeks symptoms; reduced use of antipyretics, mucolytics, and anti-
biotics; and fewer days missed from school (P < .05 for all)63

Ointment con- 2 to 5 years 5 mL Once RCT (N = 138) found reduced cough, congestion, and sleep
taining camphor, 6 to 11 years 10 mL Once difficulty compared with petrolatum ointment or no treat-
menthol, and ment (P < .05 for all)64
eucalyptus oils

Vitamin C 0 to 18 years 1 to 2 g daily 40 days to 28 Cochrane review of 29 trials found no benefit for prevent-
weeks (typi- ing colds, but reduced symptom duration by 18% (about
cally about 1 to 2 days);​​starting vitamin C supplementation after symp-
3 months) tom onset does not reduce symptom duration 16

RCT = randomized controlled trial.

Information from references 6, 16, 41, and 59-64.

286 American Family Physician [Link]/afp Volume 100, Number 5 ◆ September 1, 2019
studied in this population. P. sidoides may help with symp- INEFFECTIVE TREATMENTS
toms of acute bronchitis in children, but it has not been Table 6 summarizes the evidence of ineffective treatments
studied in children with the common cold.51 Two small tri- for children with the common cold.6,18,31,46,47,49,69
als demonstrated little or no clinically significant benefit of Antibiotics. Antibiotics provide no benefit for URI symp-
zinc in children, even with frequent doses that were started toms in terms of severity or duration.46,47 There is no role
within 24 hours of symptom onset.66,67 A Cochrane review for antibiotics in the treatment of URIs in children.
that previously reported benefit of zinc in children has been Antitussives. Neither dextromethorphan nor codeine
withdrawn.68 relieves cough in children with URIs.70,71
Bronchodilators. In a randomized
controlled trial of 59 children without
TABLE 6
asthma, oral albuterol did not improve
Ineffective Treatments for Cold Symptoms in Children acute cough at seven days compared
with placebo, but it was associated with
Treatment Study type Findings
increased adverse effects.72 Beta ago-
Antibiotics 2 Cochrane reviews No benefit for symptom duration or nists have no benefit for cough in chil-
of 11 RCTs 46,47 severity compared with no antibiot- dren without airflow restriction.72,73
ics or placebo
Increased Fluid Intake. Low-quality
Antihistamine Cochrane review of No more effective than placebo for studies suggest that increasing fluid
monotherapy 3 RCTs 6 cough intake in children with URIs actually
Antihistamine plus Cochrane review of No more effective than placebo for
causes harm.40
decongestant 2 RCTs6 cough Intranasal and Oral Corticosteroids.
Intranasal corticosteroids do not reduce
Antitussives Cochrane review of No more effective than placebo for
symptom duration or severity in chil-
3 RCTs 6 cough
dren with the common cold;​​oral corti-
Antitussive plus Cochrane review of No more effective than placebo for costeroids have not been studied for the
bronchodilator RCTs 6 cough treatment of URIs in children.50,69
Echinacea Cochrane review of No benefit for symptom severity, Complementary and Alternative
RCTs 49 peak symptom severity, number of Treatments. Steam does not improve
days of fever, or parental report of cold symptoms in children, and cau-
severity compared with placebo
tion must be used to prevent burns.31
Intranasal Cochrane review of No decrease in episodes requiring Data do not support the use of vitamin
corticosteroids 2 studies 69 oral corticosteroids, emergency D18 or echinacea49,74 in children with
department visits, hospital admis-
sions, frequency of wheezing, or
the common cold.
duration of episodes This article updates previous articles
on this topic by Fashner, et al.,75 and by
Oral prednisolone RCT of a 5-day No significant difference in dura-
Simasek and Blandino.76
course 69 tion of hospitalization, time from
admission to discharge, mean 7-day
Data Sources:​​ A primary search of
symptom score reported by parent,
or readmission for wheezing within 1
PubMed, the Cochrane database, the
month compared with placebo TRIP database, clinical guidelines from
the American College of Chest Physi-
Steam RCT of adults and No improvement in symptom sever- cians, the National Institute for Health and
children with subgroup ity with inhalation of steam for 5 Clinical Excellence, DynaMed Plus, and
analysis of 200 children minutes 3 times daily Essential Evidence Plus was completed
3 to 16 years of age31 using the key words cold, cough, respi-
ratory tract infection, upper respiratory
Vitamin D RCT of 703 children 1 2,000 IU of vitamin D did not reduce infection, nasal congestion, and rhinor-
to 5 years of age 18 overall respiratory infections com- rhea. We also searched the U.S. Food and
pared with 400 IU when taken daily
Drug Administration website for specific
for a minimum of 4 months
information regarding changes in recom-
RCT = randomized controlled trial. mendations for the use of cough and cold
medications in children. Search dates:​​
Information from references 6, 18, 31, 46, 47, 49, and 69.
September 5 to November 28, 2018, and
February 18 to July 17, 2019.

September 1, 2019 ◆ Volume 100, Number 5 [Link]/afp American Family Physician 287
 COMMON COLD

14. Seida JK, Durec T, Kuhle S. North American (Panax quinquefolius) and
The Authors Asian ginseng (Panax ginseng) preparations for prevention of the com-
mon cold in healthy adults: a​ systematic review. Evid Based Comple-
KATHARINE C. DEGEORGE, MD, MS, is an associate profes- ment Alternat Med. 2011;2011:​282151.
sor of family medicine, assistant director of the Family Medi- 15. Simancas-Racines D, Franco JV, Guerra CV, et al. Vaccines for the com-
cine Residency Program, and associate director of the Faculty mon cold. Cochrane Database Syst Rev. 2017;(5):​CD002190.
Development Fellowship at the University of Virginia Depart- 16. Hemilä H, Chalker E. Vitamin C for preventing and treating the common
ment of Family Medicine, Charlottesville. cold. Cochrane Database Syst Rev. 2013;(1):​CD000980.
17. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementa-
DANIEL J. RING, MD, is a third-year family medicine resident tion to prevent acute respiratory tract infections: ​systematic review and
at the University of Virginia Department of Family Medicine. meta-analysis of individual participant data. BMJ. 2017;356:​i6583.
18. Aglipay M, Birken CS, Parkin PC, et al.; ​TARGet Kids! Collaboration.
SARAH N. DALRYMPLE, MD, is an assistant professor of fam- Effect of high-dose vs standard-dose wintertime vitamin D supplemen-
ily medicine at the University of Virginia Department of Fam- tation on viral upper respiratory tract infections in young healthy chil-
ily Medicine. dren. JAMA. 2017;318(3):​245-254.
19. Murdoch DR, Slow S, Chambers ST, et al. Effect of vitamin D3 supple-
Address correspondence to Katharine C. DeGeorge, MD, MS, mentation on upper respiratory tract infections in healthy adults: the
University of Virginia School of Medicine, Box 800729, Char- VIDARIS randomized controlled trial. JAMA. 2012;308(13):​1 333-1339.
lottesville, VA 22908 (email:​​kd6fp@​​[Link]). Reprints are 20. Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respira-
not available from the authors. tory tract infections. Cochrane Database Syst Rev. 2015;(2):​CD006895.
21. Satomura K, Kitamura T, Kawamura T, et al.; ​G reat Cold Investigators-I.
Prevention of upper respiratory tract infections by gargling: a
​ random-
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