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Official reprint from UpToDate®

[Link] © 2022 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

The common cold in adults: Treatment and prevention

Authors: Daniel J Sexton, MD, Micah T McClain, MD, PhD
Section Editors: Mark D Aronson, MD, Martin S Hirsch, MD
Deputy Editor: Lisa Kunins, MD

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: May 2022. | This topic last updated: Mar 24, 2022.

INTRODUCTION

The common cold is a benign, self-limited syndrome representing a group of diseases caused
by members of several families of viruses. It is the most frequent acute illness in the United
States and throughout the industrialized world [1]. The term "common cold" refers to a mild
upper respiratory viral infection involving, to variable degrees, nasal congestion and discharge
(rhinorrhea), sneezing, sore throat, cough, low-grade fever, headache, and malaise. The
common cold is a separate and distinct entity, distinguishable from influenza, bacterial
pharyngitis, acute bronchitis, acute bacterial sinusitis, allergic rhinitis, and pertussis.

Treatment and prevention for the common cold are reviewed here. The epidemiology and
clinical manifestations of colds are discussed separately (see "The common cold in adults:
Diagnosis and clinical features"). Of note, these data reference management of symptoms due
to common cold viruses circulating prior to the onset of the COVID-19 pandemic (due to severe
acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). While there may well be overlap in
effect (see "COVID-19: Outpatient evaluation and management of acute illness in adults",
section on 'Symptom management and recovery expectation'), how these recommendations
apply to mild illness due to SARS-CoV-2 infection remains an area of evolving research.

PROGNOSIS

For most people and most colds, symptoms are self-limited. The common cold is usually an
uncomplicated illness; however, occasionally, patients may develop complications (eg, sinusitis,
lower respiratory tract disease, asthma exacerbations, acute otitis media). (See "The common
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cold in adults: Diagnosis and clinical features", section on 'Incubation period and symptom
duration' and "The common cold in adults: Diagnosis and clinical features", section on
'Complications'.)

MILD SYMPTOMS

Most patients with mild symptoms do not require any symptomatic therapies. Such patients
should be advised to return for review if their condition worsens or exceeds the expected time
for recovery [2,3]. (See "The common cold in adults: Diagnosis and clinical features", section on
'Incubation period and symptom duration'.)

MODERATE TO SEVERE SYMPTOMS

Symptomatic therapy remains the mainstay of common cold treatment. Patients with moderate
to severe symptoms may use a variety of therapies to relieve symptoms.

Although extensive, published reports on treatment of the common cold often suffer from
methodological flaws: inconsistent definitions of disease, different measured symptom
outcomes, mixing of subjective and objective findings, and variable age ranges. Furthermore,
most trials are complicated by the underlying (and generally incorrect) assumption that the
"common cold" is a single entity rather than a collection of widely varying viral etiologies, each
with its own pathophysiologic idiosyncrasies. Together, these often result in important
inconsistencies in reported findings. Commonly considered interventions with sufficient data
available for evaluation are discussed below.

Therapies that may be effective — The following therapies may be effective and are options
for patients with moderate to severe symptoms. Choice of therapy will depend on what
symptoms predominate, and we do not favor any one of the following treatments over others.

Analgesics — Available data suggest that acetaminophen and nonsteroidal antiinflammatory

drugs (NSAIDs) are roughly equivalent at relieving some symptoms (eg, headache, ear pain,
muscle and joint pains, malaise, and sneezing) associated with common cold, and that short
courses of standard doses in this setting are generally safe and well-tolerated [4-6]. In one
randomized trial involving nearly 400 patients with upper respiratory tract infections,
acetaminophen and NSAIDs were more effective than placebo in reducing headache, achiness,
and feverish discomfort [5]. NSAIDs may be helpful in decreasing some cold symptoms
(headache, ear pain, muscle and joint pain), but a meta-analysis found that NSAIDS did not

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improve cough or nasal discharge and did not significantly reduce the total symptom score or
duration of colds [6].

Antihistamine/decongestant combinations — The combination of antihistamines and

decongestants may be more beneficial than either component alone. Antihistamine use alone
in patients with the common cold, however, is of minimal benefit and frequently results in
troublesome side effects. (See 'Antihistamines' below.)

In a systematic review of combination products, the number needed to treat for symptom
benefit compared with placebo was 3.9 [7]. For antihistamine-analgesic-decongestant products,
the number needed to treat for benefit was 5.6. Patients experienced more adverse effects
(drowsiness, dry mouth, insomnia, and dizziness) with combination products compared with
control interventions, but the difference was not significant.

Intranasal/inhaled cromolyn sodium — Various formulations of intranasal or inhalational

cromolyn sodium are available over the counter. Cromolyn sodium administered intranasally
and/or by inhalation may improve cold symptoms. A randomized study of 118 adult patients
with symptoms of rhinorrhea, throat pain, or cough for less than 24 hours compared the use of
sodium cromoglycate dry powder (20 mg per inhalation in spincaps), sodium cromoglycate
aqueous nasal spray (5.2 mg per dose), or matching placebos every two hours during waking
hours on days 1 and 2, and four times daily on days 3 to 7 [8]. Symptoms resolved faster in
patients treated with sodium cromoglycate than with placebo. Side effects were mild and did
not differ among the three treatment groups.

Intranasal ipratropium bromide — Symptoms of rhinorrhea and sneezing may be improved

by the use of intranasal ipratropium bromide, though nasal congestion is not affected. A
systematic review of seven trials comparing ipratropium and placebo (2144 participants) found
improvement in rhinorrhea with ipratropium, although the possibility of inadequate blinding
raises the potential for bias [9]. The systematic review found a twofold increase in side effects
(nasal dryness, blood-tinged mucus, and epistaxis) in patients assigned to ipratropium.

Therapies with minimal or uncertain benefits — We generally start treatment with therapies
that may be effective. Treatments for which the balance of benefits to harms seems small or
uncertain may be reasonable options in some patients who are not able to tolerate the more
effective therapies.

Dextromethorphan — Evidence supporting the use of dextromethorphan for acute cough

due to the common cold is limited and generally poor in quality, with various studies showing
mixed results [8,9]. However, even in those studies which do demonstrate a statistically
significant benefit, the benefit is found to be small (12 to 36 percent reduction in cough events)
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[8]. Given the lack of consistent important benefit in published studies, the minor nature of the
relief seen in positive trials, and potential for side effects from misuse, we do not routinely use
dextromethorphan for acute cough due to the common cold [8,10,11].

Decongestants — Topical and oral decongestants, such as pseudoephedrine, may offer mild
relief of nasal congestion associated with the common cold when used alone [12,13]. A 2007
meta-analysis suggested a net 6 percent decrease in subjective symptoms after a single dose of
decongestant compared with use of a placebo [13]. Repeated doses of nasal decongestants
produced a small and probably clinically insignificant benefit (approximately 4 percent) over
three to five days.

● Oral – Phenylephrine is less effective than pseudoephedrine for treatment of rhinitis

symptoms. Most studies suggest that 10 mg of phenylephrine (the dose commonly used
in most cold products) is not more effective than placebo [10,14]. In the United States, the
sale of medications containing pseudoephedrine is restricted, as it can be used to
manufacture amphetamine drugs [11].

● Topical – Topical decongestant use should be limited to two to three days because
rebound rhinitis can occur after 72 hours of use. The use of topical decongestants may
occasionally be complicated by nosebleeds, agitation, insomnia, and worsened
hypertensive control in patients with preexisting hypertension. (See "An overview of
rhinitis", section on 'Nasal decongestant sprays'.)

Saline nasal spray — Saline nasal sprays may help nasal symptoms of the common cold. A
2015 systematic review of saline nasal irrigation for acute upper respiratory infections
concluded that there may be symptomatic benefits, but there was limited evidence to support
this conclusion, as the available trials were small and had a high risk of bias [15].

Expectorants — The expectorant guaifenesin had a marginal effect compared with placebo in
one randomized trial [16]. However, a 2014 systematic review concluded that there was no good
evidence for or against the effectiveness of over-the-counter medications (including
guaifenesin, mucolytics, and combination medications) for acute cough [17].

Honey — Honey is helpful in improving symptoms of upper respiratory tract infection with
cough in children [18,19] and may also be helpful in symptom management in adults. In a
meta-analysis of 14 randomized trials and observational studies including adults and children
with viral upper respiratory infection, treatment with honey or honey-containing preparations
reduced cough frequency and severity [20].

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Herbal products — Herbal preparations, including those derived from the roots of
Pelargonium sidoides (EPs 7630) and the extract of elderberry (Sambucus fructi) have been
evaluated for the management of upper respiratory tract symptoms. However, high-quality,
valid evidence of the efficacy of these botanical products is lacking [21-24], and further studies
are needed before these botanical products can be recommended.

Zinc — Although zinc preparations may decrease cold symptom severity and duration, we
suggest not using zinc because of uncertain benefits and known adverse effects, particularly
irreversible anosmia when administered intranasally. In some systematic reviews, zinc may be
associated with a reduction in the duration and severity of cold symptoms [25,26]. In one
review, zinc doses greater than 75 mg daily were effective in reducing the duration of cold
symptoms, but lower doses were not [25]. In another systematic review including 17 trials, zinc
reduced symptom duration (mean difference -1.65 days, 95% CI -2.5 to -0.8) in adults; however,
there was significant heterogeneity among trials [26]. Adverse effects, including bad taste and
nausea, were common in the zinc group in all studies.

The US Food and Drug Administration (FDA) issued a public health advisory advising that over-
the-counter zinc-containing intranasal products (Zicam) should not be used because of multiple
reports of permanent anosmia [27]. Zinc is also available in a homeopathic preparation as
intranasal zinc gluconate for the treatment and prevention for colds. This formulation has also
been found to cause hyposmia and anosmia [28]. Zinc sulfate preparations that are syrup or
lozenges seem to be better tolerated than some tablet forms [29].

Ineffective therapies — Evidence does not support the use of these therapies for treatment of
the common cold.

Antibiotic therapy — The common cold is caused by viruses and there is no indication for
antibiotic therapy in the absence of evidence of secondary bacterial infections. Treatment with
antibiotics for uncomplicated upper respiratory tract infections causes more harm than benefit
[30]. A systematic review of randomized trials in patients (including children) with upper
respiratory symptoms for fewer than seven days found that the persistence of symptoms was
identical in groups who received antibiotics or placebo (risk ratio [RR] 0.95, 95% CI 0.59-1.51)
[31]. Adults who received antibiotics had a significantly greater risk of adverse effects (RR 2.62,
1.32-5.18).

In spite of this evidence, antibiotics continue to be prescribed inappropriately in many practices.

In a retrospective cohort study of over 180,000 patients 66 years or older with nonbacterial
upper respiratory infections, the majority of which were common colds, 46 percent received an

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antibiotic prescription [32]. Improved rapid diagnostic tests and practitioner education
initiatives are needed in order to reduce such overutilization.

Antihistamines — Antihistamine use alone in patients with the common cold is of minimal
benefit and frequently results in troublesome side effects. First-generation antihistamines, such
as diphenhydramine, may alleviate rhinorrhea and sneezing, but their use is limited by side
effects such as sedation and drying of the eyes, nose, and mouth [16]. A systematic review of 18
trials concluded that antihistamines improved the severity of symptoms slightly more often
than placebo for the first one to two days of treatment but offered no benefit after 6 to 10 days
of treatment [33]. The sedating antihistamines may have small symptomatic benefits, but these
were clinically non-significant and outweighed by the frequency of side effects.

Antiviral therapies — Antiviral and NSAIDs have been studied for the treatment of the
common cold, with some evidence of effectiveness. However, the results cannot be directly
applied to patients with naturally occurring colds until the efficacy, safety, and practicality of
treatment with antiviral therapy has been demonstrated, and they are not generalizable to the
majority of colds. Directed antiviral therapy for the common cold is complicated by the wide
array of potential viral etiologies, rarity with which an etiologic agent is identified, and paucity
of agents with proven efficacy.

The combination of antiviral and NSAIDs was tested in a randomized clinical trial involving 150
healthy adults experimentally inoculated with rhinovirus, where patients were randomly
assigned to treatment with intranasal interferon (IFN)-alpha-2b (active against rhinovirus) plus
chlorpheniramine and ibuprofen, intranasal placebo plus chlorpheniramine and ibuprofen, or
intranasal and oral placebos [34]. Subjects receiving the regimen containing intranasal IFN had
a 33 to 73 percent reduction in symptom scores as well as significantly reduced volumes of
nasal mucus production and reduced virus concentrations in their nasal mucus. The incidence
of nasal dryness, nasal irritation, and blood-tinged nasal mucus was similar in all three study
groups. Although this study showed benefit of antiviral therapy with rhinovirus infections, these
results are not generalizable to the majority of colds, which are non-rhinovirus in origin. Topical
interferon for intranasal use is not currently available.

Vitamins and herbal remedies

● Vitamin C – Vitamin C is often touted as a natural remedy for the common cold. A 2013
meta-analysis of 29 trials (n = 11,306) showed a small but significant 8 percent reduction in
the duration of cold symptoms in adults regularly taking vitamin C supplements (at least
200 mg/day) [35]. This reduction was of uncertain clinical relevance. The meta-analysis

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also showed that vitamin C given therapeutically after symptom onset did not reduce
symptom duration or severity.

● Echinacea – The use of echinacea for treatment of upper respiratory tract infections
(including the common cold) is discussed separately. (See "Clinical use of echinacea",
section on 'Treatment'.)

Other

● Codeine – Although codeine is effective in suppressing chronic cough, trials in patients

with acute cough due to the common cold have found no consistent benefit of codeine
compared with placebo [17].

● Intranasal glucocorticoids – Topical glucocorticoids are not effective in treatment of the

common cold [36,37].

● Heated, humidified air – Available data do not support the use of heated, humidified air
for management of the common cold. A 2017 systematic review (six trials, 387
participants) with two trials providing data for pooling did not find unequivocal evidence
that warm vapor inhalation reduced symptoms [38]. Results were inconsistent regarding
its effect on nasal airway resistance, and one study showed no difference in viral shedding
between treatment and placebo groups. Minor side effects (eg, nasal discomfort or
irritation) were infrequently reported. Another randomized trial (performed in a "real-
world" clinical setting) that was not included in the systematic review also found no
symptomatic benefit for the use of heated, humidified air and an infrequent (2 percent)
incidence of mild thermal injury [4].

PREVENTION

Most prevention strategies for the common cold have focused on the use of vitamins, minerals,
herbs, and lifestyle changes. However, no vitamin or herbal product has been shown
conclusively to impact the incidence of the common cold.

Hand hygiene — Hygienic techniques ( table 1) such as handwashing have been shown to
prevent the spread of respiratory viruses, especially from younger children [39].

Face coverings (face masks) — High-quality data on the efficacy of face coverings as an
isolated intervention for reducing transmission of most common respiratory viruses are lacking,
in large part due to the immense challenge of designing, implementing, and conducting such
studies. However, the COVID-19 pandemic due to severe acute respiratory syndrome
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coronavirus 2 (SARS-CoV-2) has provided evidence supporting the utility of face coverings for
reducing the spread of this novel coronavirus (see "COVID-19: Epidemiology, virology, and
prevention", section on 'Wearing masks in the community'), and available data suggest overlap
in the modes of transmission of SARS-CoV-2 and common cold viruses [40,41]. Supporting data
for this conclusion and its application to the common cold include:

● Face masks have been shown to substantially decrease the spread and concentration of
exhaled droplets of the size expected to transmit SARS-CoV-2 and other similar viruses
[41]. Face masks can reduce respiratory particle emissions by up to 90 percent [42] and
can also provide meaningful reduction of exposure to particle transmission [43].

● Several ecological studies have demonstrated a reduction in COVID-19 transmission when

masks are consistently worn [44]. For example, in a study of an outbreak of SARS-CoV-2 on
the USS Theodore Roosevelt, wearing facemasks reduced infections by up to 70 percent
[45].

● Available data from 2020 to 2021 demonstrate a profound reduction in the number of
reported cases of influenza and other respiratory viral infections during the SARS-CoV-2
pandemic [46,47]. In one study, influenza infections were reduced from 13.7 to 0.73
percent, while respiratory syncytial virus (RSV) infections were reduced from 4.64 percent
to zero [46]. These data strongly suggest that the combined effect of a number of
nonpharmacologic interventions, including mask wearing, social distancing, enhanced
personal hygiene, reduced travel, and temporary lockdowns, has had a large impact on
transmission of these other common infections.

Taken together, these data strongly suggest a protective role for the wearing of facemasks to
prevent infection with many of the viral causes of the common cold, especially in conjunction
with social distancing, hand hygiene, and other nonpharmacologic measures. However, the
implications of these observations for public health policies for the prevention of respiratory
viruses other than SARS-CoV-2 are unclear.

Ineffective or uncertain preventive measures

Probiotics — Higher-quality, specific trials are needed before concluding whether probiotics
have a role in the prevention of respiratory tract infections in adults. A 2015 meta-analysis of 12
randomized trials including both children and adults comparing placebo with probiotics
(various strains of lactobacilli and Bifidobacterium) found that probiotics decreased the number
of individuals experiencing at least one episode of acute respiratory infection (odds ratio [OR]
0.53, 95% CI 0.37-0.76) and mean duration of illness (mean difference -1.89, 95% CI -2.03 to

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-1.75) [48]. The study also found that probiotic use decreased the number of prescribed
antibiotics. Overall, the quality of the evidence was low or very low.

Exercise — There have been conflicting reports regarding the efficacy of exercise in preventing
the common cold. A 2015 systematic review and meta-analysis found four randomized trials
that evaluated the effect of exercise on the number of acute respiratory infections per year [49].
However, only two were included in the meta-analysis due to lack of clarity of data in the other
two [50,51]. The meta-analysis found no differences in the number of acute respiratory
infection episodes between exercise and nonexercise groups. The two randomized trials that
were included had disparate results. One randomized trial of 115 overweight, sedentary,
postmenopausal women found that moderate intensity exercise sustained over one year
appeared to decrease the incidence of self-reported colds [50]. The risk of cold was three times
higher in the control group (once weekly stretching) compared with the intervention group
(exercising five times a week). Several factors may have influenced these results: the diagnosis
of cold was based on self-reporting, the overall incidence of upper respiratory infections was
not different between groups, and the rate of influenza vaccine usage was higher among
controls. A subsequent randomized trial, compared no intervention with exercise (45 minutes
daily at home plus 2.5 hours per week of group sessions) or mindfulness meditation [51]. There
was no effect of exercise on the incidence of acute respiratory illness, severity of symptoms, or
missed work days, although there were trends toward a positive effect; meditation was
associated with self-reported decreased global symptom severity and fewer missed days.

Sleep — There are some data suggesting that duration of sleep influences overall risk of
developing the common cold. In one clinical trial, individuals were experimentally inoculated
with human rhinovirus and those who slept <5 hours per night at baseline were almost
threefold more likely to develop a cold than those who slept >7 hours per night [52]. However,
the generalizability of these findings to naturally acquired infections or infections with other
cold viruses has not been proven.

Zinc — A systematic review of two randomized trials in children found that zinc sulfate, taken
for a minimum of five months, decreased the rate of development of colds and school absence
[53]. The generalizability of this finding to adults, in whom colds occur less frequently, is not
known. Additionally, intranasal zinc may cause anosmia, and it is felt that the risks outweigh any
potential benefit thus far observed in clinical trials. (See 'Zinc' above.)

Vitamins

● Vitamin C – A 2013 meta-analysis of 29 trials showed that regular supplementation with

vitamin C did not significantly reduce the incidence of colds [35]. However, there was a 50

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percent decrease in the incidence of colds in a subset of patients exposed to vigorous

activity, especially in extreme conditions (marathon runners, skiers, and soldiers in sub-
arctic). The reasons for the apparent benefit in this subset of patients are uncertain.

● Vitamin D – A role for vitamin D in the prevention of upper respiratory infections was
suggested by data from a United States survey population (3rd NHANES) that found a
relationship between higher serum levels of 25-hydroxyvitamin D and fewer reported
respiratory infections [54]. However, two large randomized trials found no difference in
the incidence of upper respiratory infections for groups receiving vitamin D3 (monthly
injection [55] or oral supplement 1000 international units/day [56]) or placebo. (See
"Vitamin D and extraskeletal health", section on 'Immune system'.)

● Vitamin E – Existing data do not convincingly support the use of vitamin E in the
prevention of the common cold. The efficacy of vitamin E (200 international units/day) in
preventing respiratory tract infections was addressed in a randomized controlled trial in
older adult nursing home residents [57]. Although vitamin E did not have a statistically
significant positive effect on the overall risk of lower respiratory infections, a post hoc
analysis suggested a modest reduction in the incidence of the common cold (0.67 versus
0.81 per person per year, relative risk [RR] 0.83, 95% CI.68-1.01) in patients receiving
vitamin E. In addition, fewer patients treated with vitamin E had multiple colds (40 versus
48 percent). Findings from such post hoc analyses should be viewed with skepticism
unless further studies confirm a benefit. In addition, studies have shown that higher-dose
vitamin E (400 international units/day or greater) may increase all-cause mortality and
should be avoided [58]. (See "Overview of vitamin E".)

Herbal products — No herbal product has been conclusively shown to significantly impact the
incidence of the common cold [59,60].

Other

● Gargling – A randomized trial in 387 healthy adults compared self-reported symptoms of

upper respiratory infection over 60 days in three groups: usual care (controls), gargling
with water three times daily, and gargling with povidone-iodine [61]. Patients who gargled
with water, compared with controls, reported fewer incidents of cold symptoms (hazard
ratio [HR] 0.64, 95% CI 0.41-0.99) while no effect was seen for those who gargled with
povidone. The subjective outcome in this unblinded trial call into question the validity of
these findings.

● Leukotriene receptor antagonists – A single study suggested that leukotriene receptor

antagonists (LTRAs, such as montelukast) may decrease the incidence of common cold-like
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symptoms in children with asthma [62]. This finding was confirmed by a subsequent trial
in adults [63]. Thus far, cold symptom prevention with LTRAs has not been studied in
patients without asthma.

INFORMATION FOR PATIENTS

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the
Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade
reading level, and they answer the four or five key questions a patient might have about a given
condition. These articles are best for patients who want a general overview and who prefer
short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more
sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading
level and are best for patients who want in-depth information and are comfortable with some
medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print
or e-mail these topics to your patients. (You can also locate patient education articles on a
variety of subjects by searching on "patient info" and the keyword(s) of interest.)

● Basics topics (see "Patient education: Sinusitis in adults (The Basics)" and "Patient
education: Acute bronchitis (The Basics)" and "Patient education: What you should know
about antibiotics (The Basics)")

● Beyond the Basics topics (see "Patient education: The common cold in adults (Beyond the
Basics)" and "Patient education: Acute sinusitis (sinus infection) (Beyond the Basics)" and
"Patient education: Acute bronchitis in adults (Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

● Symptoms generally self-limited – For most people and most colds, symptoms are self-
limited. The usual course and duration of illness is up to one and a half weeks. (See
'Prognosis' above.)

● Therapy not warranted for patients with mild symptoms – Patients with mild
symptoms most often do not require any symptomatic therapies. Patients should be
advised to return for review if their condition worsens or exceeds the expected time for
recovery. (See 'Mild symptoms' above.)

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● Symptomatic therapy an option for patients with moderate to severe symptoms –

Symptomatic therapy remains the mainstay of common cold treatment. Patients with
moderate to severe symptoms may use a variety of therapies to relieve symptoms. (See
'Moderate to severe symptoms' above.)

• Treatments that may have efficacy – Choice of therapy will depend on what
symptoms predominate, and we do not favor any one of the following treatments over
others. (See 'Therapies that may be effective' above.)

- Analgesics may be used to relieve associated symptoms (eg, headache, ear pain,
muscle and joint pains, malaise, and sneezing). (See 'Analgesics' above.)

- Symptomatic treatments for nasal symptoms that have moderate evidence of

efficacy include a combination product containing an antihistamine and a
decongestant, intranasal/inhaled cromolyn sodium, or intranasal ipratropium
bromide. (See 'Antihistamine/decongestant combinations' above and
'Intranasal/inhaled cromolyn sodium' above and 'Intranasal ipratropium bromide'
above.)

• Treatments of minimal or uncertain benefit – Decongestants, saline nasal spray,

cough suppressants, and expectorants, and honey are of minimal or uncertain benefit.
(See 'Therapies with minimal or uncertain benefits' above.)

Although zinc sulfate lozenges and syrup may decrease cold symptom severity and
duration, we suggest not using any zinc preparations because of uncertain benefits
and known toxicities, including irreversible anosmia when administered intranasally
(Grade 2C). (See 'Zinc' above.)

● Ineffective therapies – There is no evidence to support the use of antibiotics,

antihistamines, antiviral therapies, or vitamins and herbal remedies in the treatment of
the common cold. Antibiotic treatment causes more harm than benefit. (See 'Ineffective
therapies' above.)

● Prevention - Hygienic measures such as handwashing ( table 1), facemasks, and social
distancing, especially when unwell, can reduce the spread of respiratory viruses. No
vitamin or herbal product has been shown conclusively to impact the incidence of the
common cold. (See 'Prevention' above.)

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REFERENCES

1. Kirkpatrick GL. The common cold. Prim Care 1996; 23:657.

2. Tan T, Little P, Stokes T, Guideline Development Group. Antibiotic prescribing for self
limiting respiratory tract infections in primary care: summary of NICE guidance. BMJ 2008;
337:a437.

3. National Institute for Health and Care Excellence. Respiratory tract infections (self-limiting):
prescribing antibiotics. July 2008. Available at: [Link] (Acc
essed on July 03, 2019).

4. Little P, Moore M, Kelly J, et al. Ibuprofen, paracetamol, and steam for patients with
respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ 2013;
347:f6041.

5. Bachert C, Chuchalin AG, Eisebitt R, et al. Aspirin compared with acetaminophen in the
treatment of fever and other symptoms of upper respiratory tract infection in adults: a
multicenter, randomized, double-blind, double-dummy, placebo-controlled, parallel-group,
single-dose, 6-hour dose-ranging study. Clin Ther 2005; 27:993.
6. Kim SY, Chang YJ, Cho HM, et al. Non-steroidal anti-inflammatory drugs for the common
cold. Cochrane Database Syst Rev 2015; :CD006362.
7. De Sutter AI, Eriksson L, van Driel ML. Oral antihistamine-decongestant-analgesic
combinations for the common cold. Cochrane Database Syst Rev 2022; 1:CD004976.
8. Aberg N, Aberg B, Alestig K. The effect of inhaled and intranasal sodium cromoglycate on
symptoms of upper respiratory tract infections. Clin Exp Allergy 1996; 26:1045.
9. AlBalawi ZH, Othman SS, Alfaleh K. Intranasal ipratropium bromide for the common cold.
Cochrane Database Syst Rev 2013; :CD008231.

10. Horak F, Zieglmayer P, Zieglmayer R, et al. A placebo-controlled study of the nasal

decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge
Chamber. Ann Allergy Asthma Immunol 2009; 102:116.

11. US Food and Drug Administration. Phenylpropanolamine (PPA) information page. Available
at: [Link] (Acces
sed on March 28, 2007).

12. De Sutter AI, van Driel ML, Kumar AA, et al. Oral antihistamine-decongestant-analgesic
combinations for the common cold. Cochrane Database Syst Rev 2012; :CD004976.
13. Taverner D, Latte J. Nasal decongestants for the common cold. Cochrane Database Syst Rev
2007; :CD001953.

[Link] 13/19
6/19/22, 7:21 PM 6868

14. Hatton RC, Winterstein AG, McKelvey RP, et al. Efficacy and safety of oral phenylephrine:
systematic review and meta-analysis. Ann Pharmacother 2007; 41:381.
15. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper
respiratory tract infections. Cochrane Database Syst Rev 2015; :CD006821.
16. Turner RB. Epidemiology, pathogenesis, and treatment of the common cold. Ann Allergy
Asthma Immunol 1997; 78:531.

17. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in
children and adults in community settings. Cochrane Database Syst Rev 2014; :CD001831.
18. Cohen HA, Rozen J, Kristal H, et al. Effect of honey on nocturnal cough and sleep quality: a
double-blind, randomized, placebo-controlled study. Pediatrics 2012; 130:465.
19. Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children.
Cochrane Database Syst Rev 2018; 4:CD007094.
20. Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper
respiratory tract infections: a systematic review and meta-analysis. BMJ Evid Based Med
2021; 26:57.
21. Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients
with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore
(NY) 2007; 3:573.
22. Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation
from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled,
multicentre study. Curr Med Res Opin 2007; 23:323.

23. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety
of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med
Res 2004; 32:132.

24. Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the sambuci fructus effect
and efficacy profiles. Phytother Res 2010; 24:1.
25. Hemilä H. Zinc lozenges may shorten the duration of colds: a systematic review. Open
Respir Med J 2011; 5:51.
26. Science M, Johnstone J, Roth DE, et al. Zinc for the treatment of the common cold: a
systematic review and meta-analysis of randomized controlled trials. CMAJ 2012; 184:E551.
27. [Link] (Accessed on April
04, 2011).

28. Davidson TM, Smith WM. The Bradford Hill criteria and zinc-induced anosmia: a causality
analysis. Arch Otolaryngol Head Neck Surg 2010; 136:673.
[Link] 14/19
6/19/22, 7:21 PM 6868

29. Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev 2011; :CD001364.
30. Harris AM, Hicks LA, Qaseem A, High Value Care Task Force of the American College of
Physicians and for the Centers for Disease Control and Prevention. 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. Ann
Intern Med 2016; 164:425.
31. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane
Database Syst Rev 2013; :CD000247.
32. Silverman M, Povitz M, Sontrop JM, et al. Antibiotic Prescribing for Nonbacterial Acute
Upper Respiratory Infections in Elderly Persons. Ann Intern Med 2017; 166:765.
33. De Sutter AI, Saraswat A, van Driel ML. Antihistamines for the common cold. Cochrane
Database Syst Rev 2015; :CD009345.
34. Gwaltney JM Jr, Winther B, Patrie JT, Hendley JO. Combined antiviral-antimediator treatment
for the common cold. J Infect Dis 2002; 186:147.

35. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane
Database Syst Rev 2013; :CD000980.
36. Mygind N, Andersson M. Topical glucocorticosteroids in rhinitis: clinical aspects. Acta
Otolaryngol 2006; 126:1022.
37. Hayward G, Thompson MJ, Perera R, et al. Corticosteroids for the common cold. Cochrane
Database Syst Rev 2015; :CD008116.

38. Singh M, Singh M, Jaiswal N, Chauhan A. Heated, humidified air for the common cold.
Cochrane Database Syst Rev 2017; 8:CD001728.
39. Jefferson T, Del Mar C, Dooley L, et al. Physical interventions to interrupt or reduce the
spread of respiratory viruses. Cochrane Database Syst Rev 2010; :CD006207.
40. Cevik M, Kuppalli K, Kindrachuk J, Peiris M. Virology, transmission, and pathogenesis of
SARS-CoV-2. BMJ 2020; 371:m3862.
41. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, et al. Effectiveness of Face Masks in Preventing
Airborne Transmission of SARS-CoV-2. mSphere 2020; 5.
42. Asadi S, Cappa CD, Barreda S, et al. Efficacy of masks and face coverings in controlling
outward aerosol particle emission from expiratory activities. Sci Rep 2020; 10:15665.
43. van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce
exposure to respiratory infections among the general population. PLoS One 2008; 3:e2618.

44. Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread of SARS-
CoV-2. JAMA 2021; 325:998.
[Link] 15/19
6/19/22, 7:21 PM 6868

45. Payne DC, Smith-Jeffcoat SE, Nowak G, et al. SARS-CoV-2 Infections and Serologic
Responses from a Sample of U.S. Navy Service Members - USS Theodore Roosevelt, April
2020. MMWR Morb Mortal Wkly Rep 2020; 69:714.
46. Yang Q, Xiao X, Gu X, et al. Surveillance of common respiratory infections during the
COVID-19 pandemic demonstrates the preventive efficacy of non-pharmaceutical
interventions. Int J Infect Dis 2021; 105:442.
47. Chan KH, Lee PW, Chan CY, et al. Monitoring respiratory infections in covid-19 epidemics.
BMJ 2020; 369:m1628.
48. Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections.
Cochrane Database Syst Rev 2015; :CD006895.
49. Grande AJ, Keogh J, Hoffmann TC, et al. Exercise versus no exercise for the occurrence,
severity and duration of acute respiratory infections. Cochrane Database Syst Rev 2015;
:CD010596.
50. Chubak J, McTiernan A, Sorensen B, et al. Moderate-intensity exercise reduces the
incidence of colds among postmenopausal women. Am J Med 2006; 119:937.
51. Barrett B, Hayney MS, Muller D, et al. Meditation or exercise for preventing acute
respiratory infection: a randomized controlled trial. Ann Fam Med 2012; 10:337.
52. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally Assessed Sleep and
Susceptibility to the Common Cold. Sleep 2015; 38:1353.
53. Singh M, Das RR. Zinc for the common cold. Cochrane Database Syst Rev 2013; :CD001364.
54. Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D
level and upper respiratory tract infection in the Third National Health and Nutrition
Examination Survey. Arch Intern Med 2009; 169:384.
55. Murdoch DR, Slow S, Chambers ST, et al. Effect of vitamin D3 supplementation on upper
respiratory tract infections in healthy adults: the VIDARIS randomized controlled trial. JAMA
2012; 308:1333.
56. Rees JR, Hendricks K, Barry EL, et al. Vitamin D3 supplementation and upper respiratory
tract infections in a randomized, controlled trial. Clin Infect Dis 2013; 57:1384.
57. Meydani SN, Leka LS, Fine BC, et al. Vitamin E and respiratory tract infections in elderly
nursing home residents: a randomized controlled trial. JAMA 2004; 292:828.
58. Miller ER 3rd, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E
supplementation may increase all-cause mortality. Ann Intern Med 2005; 142:37.
59. Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database Syst Rev
2014; :CD006206.
[Link] 16/19
6/19/22, 7:21 PM 6868

60. Seida JK, Durec T, Kuhle S. North American (Panax quinquefolius) and Asian Ginseng (Panax
ginseng) Preparations for Prevention of the Common Cold in Healthy Adults: A Systematic
Review. Evid Based Complement Alternat Med 2011; 2011:282151.
61. Satomura K, Kitamura T, Kawamura T, et al. Prevention of upper respiratory tract infections
by gargling: a randomized trial. Am J Prev Med 2005; 29:302.
62. Bisgaard H, Zielen S, Garcia-Garcia ML, et al. Montelukast reduces asthma exacerbations in
2- to 5-year-old children with intermittent asthma. Am J Respir Crit Care Med 2005; 171:315.

63. Horiguchi T, Ohira D, Kobayashi K, et al. Clinical evaluation of leukotriene receptor

antagonists in preventing common cold-like symptoms in bronchial asthma patients.
Allergol Int 2007; 56:263.
Topic 6868 Version 60.0

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GRAPHICS

Hand-hygiene technique

When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand
and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Follow the
manufacturer's recommendations regarding the volume of product to use.

When washing hands with soap and water, wet hands first with water, apply an amount of product
recommended by the manufacturer to hands, and rub hands together vigorously for at least 20
seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly
with a disposable towel. Use towel to turn off the faucet.

Liquid, bar, leaflet, or powdered forms of plain soap are acceptable when washing hands with soap
and water. When bar soap is used, small bars of soap and soap racks that facilitate drainage should
be used.

Multiple-use cloth towels of the hanging or roll type are not recommended for use in health care
settings.

Data from:

1. Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 2002; 51(RR-16):1.
2. Centers for Disease Control and Prevention. When & How to Wash Your Hands. Available at:
[Link] (Accessed on October 11, 2019).

Graphic 77676 Version 7.0

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Contributor Disclosures
Daniel J Sexton, MD Equity Ownership/Stock Options: Magnolia Medical Technologies [Medical
diagnostics]. Consultant/Advisory Boards: Magnolia Medical Technologies [Medical diagnostics]. All of the
relevant financial relationships listed have been mitigated. Micah T McClain, MD,
PhD Grant/Research/Clinical Trial Support: United States Department of Veterans Affairs Merit Review
[Tick-borne diseases]. All of the relevant financial relationships listed have been mitigated. Mark D
Aronson, MD No relevant financial relationship(s) with ineligible companies to disclose. Martin S Hirsch,
MD No relevant financial relationship(s) with ineligible companies to disclose. Lisa Kunins, MD No
relevant financial relationship(s) with ineligible companies to disclose.

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be
provided to support the content. Appropriately referenced content is required of all authors and must
conform to UpToDate standards of evidence.

Conflict of interest policy

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