Common Cold: Diagnosis and Treatment

First, we check for serious illness

We assess temperature, blood pressure, pulse, breathing rate, oxygen saturation and general condition. Pneumonia, an asthma attack, acute epiglottitis, a peritonsillar abscess or sepsis can resemble a cold and need prompt care.

• Breathlessness, chest pain, blue lips or low oxygen levels.
• Confusion, inability to stand or low blood pressure.
• Inability to swallow saliva, drooling, difficulty opening the mouth or difficulty speaking.
• Persistent high fever, worsening after initial improvement, inability to drink or reduced urination.

Which symptoms are most prominent?

Influenza or COVID-19 tests may be considered according to symptoms, exposure and circulating infections. Chest imaging and blood tests are selected when pneumonia or another condition is suspected.

• Common cold: runny or blocked nose, sore throat and cough occur together; most cases are viral.
• Acute rhinosinusitis: nasal symptoms may accompany cheek or forehead pain and purulent discharge. Mild cases are initially observed without antibiotics.
• Acute pharyngitis: sore throat is prominent. A rapid group A streptococcal (GAS) test may be considered based on findings such as fever, tender neck glands, tonsillar exudate and absence of cough.
• Acute bronchitis: cough predominates and may last two to three weeks. Sputum colour alone cannot establish bacterial infection.

The usual treatment approach

Antibiotics do not treat the viruses causing an ordinary cold or shorten recovery. They can cause adverse effects and contribute to antibiotic resistance. Rest, sleep and fluids are the foundation; we select only the medicines needed for troublesome symptoms, for a short period.

Medicine precautions

• Paracetamol (acetaminophen) may be used for pain or fever. Do not combine products containing it or take more than prescribed; liver disease and alcohol use require care.
• Combination cold products such as PL contain several ingredients and can cause drowsiness. PL must not be combined with other acetaminophen products; avoid driving and tell the clinician about glaucoma, difficulty urinating, ulcers, aspirin-sensitive asthma or liver disease.
• Medicines for sputum or dry cough are chosen according to symptoms. Cough suppressants can cause drowsiness and interact with other medicines; avoid excessive cough suppression when there is much sputum.
• Codeine is not a standard treatment for an acute cold at our clinic because evidence of benefit is lacking and risks include respiratory depression, drowsiness, constipation and dependence.
• Tranexamic acid may be considered for selected throat symptoms, with attention to thrombosis risk and kidney function.
• Montelukast may be selected for allergic rhinitis or coexisting asthma. It is not routinely added for a blocked nose caused only by an ordinary viral cold.

When antibiotics may be appropriate

• GAS pharyngitis: antibiotics are generally started after a positive rapid test or culture. While awaiting results, pain and fever relief, fluids and rest continue. Rapid deterioration requires reassessment without waiting for the result.
• Possible bacterial rhinosinusitis: severity, symptoms persisting without improvement for more than ten days, high fever with purulent discharge, or deterioration after improvement help guide the decision. Mild cases are initially observed for five days without antibiotics.
• Acute bronchitis: antibiotics are not used unless another diagnosis such as pneumonia or pertussis is identified. Yellow or green sputum alone is not a reason to prescribe them.

When to return or seek urgent help

• Seek urgent care for breathlessness, chest pain, confusion or inability to swallow saliva.
• Return if fever lasts three to four days or longer, cough or general condition worsens, or symptoms worsen again after improvement.
• A cough lasting three weeks or longer, blood in sputum or weight loss needs reassessment for another cause.

Returning to work or school

Return-to-work and school guidance depends on the infection and the setting. Check your employer's or school's requirements, especially for healthcare, care work, childcare and food handling.

About this summary and references

This English summary follows the assessment, treatment and safety advice in the Japanese clinic article. The full article includes representative adult prescriptions and medicine-specific references.