What's the Best Treatment for a Cold?

A fellow caregiver asked...

What's the best treatment for a cold?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

The best way to treat a cold is to rest and treat symptoms if necessary. Since colds are due to viruses, antibiotics have not been shown to help, and in some cases they can be harmful.

The major symptoms of the common cold can be treated in the following ways:

Fever

  • Of the several drugs used to reduce fever, acetaminophen (Tylenol) is the safest.

  • Nonsteroidal anti-inflammatories (NSAIDs) such as Ibuprofen are fine for younger people who don't have kidney disease or ulcers.

Nasal congestion

  • Decongestants such as pseudoephedrine (Sudafed) help some people. Try not to use decongestants for more than a few days, however, or you can start getting a rebound runny nose.

  • Phenylephrine is now more widely available than pseudoephedrine -- many pharmacies place restrictions on pseudoephedrine because it can be used to manufacture methamphetamine. Phenylephrine doesn't work as well, though. In fact, in some studies the usual over-the-counter dose was no better than a placebo. If you want to try a decongestant, ask for pseudoephedrine, which is often kept behind the counter.

  • Antihistamines such as Benadryl have been shown by studies to be less helpful than pseudoephedrine. Also, the elderly should use antihistamines with caution because they can lead to confusion and falls.

  • Nasal steroids are not proven to help with the common cold, although they do work well for congestion due to allergies.

Cough

  • Experts are divided. The American College of Chest Physicians doesn't recommend cough suppressants for cough due to the common cold, but some studies have shown a small benefit from dextromethorphan, which is the most common ingredient in cough syrup.

  • Cough syrup is fine to use, but don't expect miracles; all it can do is partially relieve symptoms.

Zinc lozenges are sold at health food stores and some pharmacies as an over-the-counter supplement to treat the common cold. But the results of scientific studies have been mixed, and there have been reports of permanent changes to sense of smell associated with use of OTC zinc treatments. In June 2009, the FDA issued an advisory regarding some of these zinc products, so be cautious about using them.

Most colds get better on their own within two weeks, and the majority of cold sufferers eventually recover without seeing a doctor. However, a small minority of colds may lead to a subsequent bacterial infection, such as sinusitis or pneumonia. If you're getting worse or are still concerned about symptoms after two weeks, call your doctor.