Common cold (acute viral rhinitis)

Overview

•Self-limiting upper respiratory tract infection - most commonly caused by rhinovirus (30-50% of cases)

•Adults average 2-4 colds/year; children 6-8/year

•Incubation 1-3 days; illness lasts 7-10 days (cough may persist up to 3 weeks)

Presentation

•Nasal congestion, rhinorrhoea, sneezing, sore throat, cough, low-grade fever, malaise

•Rhinorrhoea starts clear, becomes mucopurulent (yellow/green) after day 3-5 - this is normal neutrophil influx and does not indicate bacterial superinfection

•High fever (>38.5°C) or prominent myalgia should prompt consideration of influenza

⚠️

Mucopurulent nasal discharge is NOT an indication for antibiotics - it is a normal stage of the viral illness.

Investigations

•No investigations required - clinical diagnosis in uncomplicated cases

•FBC and CRP - only if bacterial superinfection suspected (fever persisting beyond 5 days or worsening after initial improvement)

Management

🥇 First-line

•adequate hydration and rest

•paracetamol or ibuprofen - for fever, headache, sore throat

•saline nasal irrigation/drops - especially useful in children where decongestants are contraindicated

🥈 Second-line

•xylometazoline or oxymetazoline nasal spray (adults and children >12) - max 5-7 days to avoid rebound rhinitis (rhinitis medicamentosa)

•oral pseudoephedrine - avoid in hypertension, cardiovascular disease, thyroid disease

•Honey (children >1 year) - evidence supports use for cough; do NOT use in children under 12 months (infant botulism risk)

•Combination OTC cold remedies - not recommended in children under 6; caution in ages 6-12; warn about paracetamol double-dosing

🎯

Antibiotics are NOT indicated for the common cold. A delayed/back-up prescription may be appropriate in genuinely uncertain cases, but the default is no antibiotic.

Complications

•Acute bacterial sinusitis - worsening after initial improvement beyond day 10, unilateral facial pain, fever

•Acute otitis media - especially children; otalgia and hearing loss

•Asthma exacerbation - rhinovirus is the most common trigger

•COPD exacerbation - rhinovirus and RSV are the most common precipitants

•Lower respiratory tract infection - in infants, elderly, immunosuppressed

🚨

Safety-net - return if: symptoms worsen after initial improvement, fever persists beyond 5 days or rises again, unilateral facial/dental pain, otalgia with hearing loss, breathlessness or wheeze, or patient is immunocompromised.