Table 2:

Pharmacologic interventions for the treatment of the common cold

InterventionFormulation and doseEvidenceRisk of biasOutcomeHarmsComment
Antihistamine, monotherapy51,52Various antihistamines2 meta-analyses (9 RCTs in first, n = 1023 adults; 32 RCTs in second, n = 8930 adults and children); total 22 RCTsModerate (some trial quality issues and conflicting results)Overall symptoms and nasal obstruction not improved; subjective improvement in rhinorrhea and sneezing at days 2–4 statistically significant but not clinically significant (scores generally ≤ 0.3 on scale of 4–5)Adverse events (primarily sedation) increased with first-generation antihistamines (Peto OR 1.25, 95% CI 1.04–1.50); no increase with nonsedating antihistaminesNo clinically meaningful benefit
Antihistamine, combination therapy53Antihistamine plus decongestant or analgesic or bothMeta-analysis (27 RCTs; n = 5117 adults and children)High (trial quality issues common, and conflicting results)Best evidence for antihistamine– decongestant combination (NNT = 5 for global symptoms); other combinations had small to moderate effects in adults and older childrenSome increased adverse events (insomnia and dry mouth) with antihistamine– decongestant combination; no statistically significant differences with other combinationsLikely beneficial in adults and older children; no effect in children ≤ 5 yr
Decongestant5457Oral phenylephrine and topical nasal decongestant3 meta-analyses and 1 systematic review (4–15 RCTs)High (limited quality information available)Oral and topical decongestants: small, statistically significant effect on nasal airway resistance, but no consistent clinical effect; no data for childrenNo consistent effect on heart rate or blood pressure; small increase in insomniaSmall benefit but uncertain clinical significance; no data for children
Intranasal ipratropium58Ipratropium 42–168 μg (1–2 sprays 3–4 times per day)Meta-analysis (7 RCTs; n = 2144 adults and children ≥ 5 yr)Moderate (some trial quality issues)Improved rhinorrhea but not nasal congestion; at 24 h, 87% of ipratropium group v. 73% of control group rated themselves as much better or better (p = 0.004)Increased epistaxis, nasal dryness and mouth drynessProbable benefit
Over-the-counter cough treatments58Antitussives, antihistamines, mucolytics, expectorants, alone or in combination*Meta-analysis (8 RCTs, n = 616 children; 18 RCTs, n = 3421 adults)High (multiple trial quality issues and conflicting results)Children: no benefit Adults: some inconsistent benefit with some combinations and dextromethorphanInconsistently reportedNo benefit in children; benefit unclear (but likely small) in adults
Vapour rub595–10 mL rubbed on chest and neck one nightRCT (n = 138 children, age 2–11 yr)Moderate (poorly described randomization, blinding limited, single study)No improvement in cough or rhinorrhea but small improvement in sleep for child and parent compared with placeboSignificant increase in adverse events (burning of skin, eyes and nose)Unclear benefit, but harms present
NSAID607 different NSAIDs used (ibuprofen most common)Meta-analysis (9 RCTs; n = 1069 adults)Moderate (main limitation was missing information on randomization)No improvement in duration of cold, overall symptoms or most respiratory symptoms; improvement in some pain areas (ear, muscles, headache) but not sore throatNonsignificant trend to increased adverse events (risk ratio 2.94, 95% CI 0.51 to 17.03)Likely beneficial for pain; no benefit for other symptoms
Acetaminophen (paracetamol)61641000 mg 4 times daily in adults or 15 mg/kg in children2 RCTs (n = 90 children, 392 adults), plus 2 meta-analyses focused on feverModerate (few trials with limited randomization and allocation information)Overall, acetaminophen was more effective than placebo in reducing fever and providing mild analgesia; it was less effective than ibuprofen in fever control (in children)Adverse events higher with 1000 mg acetaminophen v. (25% v. 5%, p < 0.001); all events were mild or moderate (e.g., sweating)Likely effective for fever and analgesia v. placebo; inferior to ibuprofen for fever control
Antibiotic65Various antibioticsMeta-analysis (6 RCTs; n = 1047 adults and children)Moderate (some trial quality concerns and inconsistent results)No effect on reduction of persistent symptoms (risk ratio 0.95, 95% CI 0.59 to 1.51)Adverse events increased (relative risk 1.8, 95% CI 1.01 to 3.21)No benefit, and harms present
  • Note: CI = confidence interval, NNT = number needed to treat, NSAIDs = nonsteroidal anti-inflammatory drugs, OR = odds ratio, RCT = randomized control trial.

  • * Includes dextromethorphan, codeine, letosteine, brompheniramine–phenylpropanolamine, guaifenesin, pseudophedrine, diphenhydramine, chlorpheniramine, clemastine and combinations.