The Common Cold: Treatment Options

Unfortunately if you were like me you would be battling your third viral infection in as many months.

I was hit up with the cold at the end of November and early December. Then after only two shifts in January in the Emergency Department I caught the stomach flu. Now in February I have acquired the common cold again, despite my frantic hand washing, which is the most effective way to prevent the cold.

The cold and stomach flu are both caused by viruses, but not the same virus. The stomach flu, called viral gastroenteritis, can be due to a wide variety of viruses, but most commonly the Norwalk (formerly the noro-virus) and Rotavirus are the culprits. The common cold, diagnosed as a viral upper respiratory infection (URI), is caused by Coronavirus.

We all know the symptoms of a common cold; low grade fever, fatigue/malaise, rhinorrhea (runny nose), sore throat, productive or non-productive cough, sinus congestion, back aches, etc. All of these symptoms are somewhat non-specific, but in the proper setting, with adequate clinical experience and common physical exam findings the diagnosis of a viral URI is fairly easy and should be at the top of a differential diagnosis.

However, a physician must always think of what else could be causing these symptoms and develop a thorough differential diagnosis. An atypical pneumonia, such as that caused by mycoplasma, or a viral pneumonia may have similar presentation as the common cold. Strep throat, sinusitis and mononucleosis can also present in this manner. On a more serious, but less common level a differential could also include lymphoma or even HIV. Early HIV often presents with vague, cold-like symptoms.

Close to 95% of all URI are viral, so it is easy to dismiss many of these other diseases placed into the differential. The problem with viral infections, especially with the coronavirus, is they will not respond to antibiotics (which only target bacteria) and anti-viral medications are often expensive and ineffective. Moreover, even without treatment the common cold should dissipate after 7-10 days. Thus, supportive therapy and controlling symptoms is the only way to “treat” a viral URI.

So what treatments work? There are not a lot of evidence based clinical trials addressing the treatment of the common cold. Many physicians just rely on their clinical and personal experiences in treating this benign but annoying condition. One physician I worked with used what I termed the RFT treatment – rest, fluids and Tylenol. Another physician prescribed a medication that contained guaifenesin and pseudoephedrine to treat a viral URI. And another physician thought everything could potentially be pneumonia and prescribed one of the most expensive antibiotics on the market to anyone with fatigue and a cough. I don’t recommend the last treatment.

Here’s what I have developed by ripping off the name of some Emergency Department (ED) shotgun treatments. In the ED patients presenting with an altered mental status may receive a “coma cocktail” or if they have heartburn symptoms and an acute myocardial infarction can be ruled out very early, they may receive a “GI cocktail.” So I have come up with a “cold cocktail.”

Disclaimer – there is no randomized controlled clinical trial supporting this treatment. It is based on clinical experiences and has been shown CLINICALLY to be effective. If you believe you have a common cold, you may try this regimen, but if your symptoms worsen or do not improve over a week you should see a physician.

Andy’s Cold Cocktail:
1. Mucinex DM – this medication contains guaifenesin and dextromethorphan (DM). The guaifenesin is an expectorant and will loosen up the mucus production in the upper respiratory tract and the dextromethorphan will suppress the cough, which will help decrease the inflammation from continual paroxysms of coughing. (DM mechanism of action is much more complicated, but essentially that is what it does.)
2. Sudafed – pseudoephedrine is an alpha 1 agonist and therefore constricts blood vessels. If one has high blood pressure, this medication should not be used. However, if one is normotensive this medication will decrease a runny nose by constricting the vasculature in the nose.
3. Ibuprofen – any non-steroidal anti-inflammatory (NSAIDs) will work. I like naproxen over all the other NSAIDs. I take three 220 mg tablets to help with any aches and pains. This medication should be taken with food and avoided if you have a history of stomach ulcers. I prefer NSAIDs to acetaminophen because the latter also decreases inflammation and acetaminophen does not have anti-inflammatory actions. Any infection will cause some level of inflammation so I believe using a medication to decrease inflammation, if it can be tolerated, will be more efficacious than a medication that does not.
4. Rest – take the day off and let your body do some of the work to fight off this infection.
5. Fluids – with any infection the body will use all of its resources to fight it off and maintaining fluid homeostasis is always imperative.
6. Cough drops – this is purely symptomatic, but can temporarily alleviate the cough as well as some congestion.
7. Osteopathic manipulation – if I’m around or your physician is able to provide OMM it really does help. The sympathetic nervous system innervates the lungs at the thoracic vertebrae from T2-T9 and the head from T1-T4. Soft tissue techniques to these areas can help reduce the sympathetic overflow, which will decrease inflammation as well as suppress the cough, decrease nasal drainage and congestion. Also, cranial techniques to help with sinus drainage in the head and neck will alleviate many symptoms found in the common cold.

This is a very comprehensive treatment regimen. It has not been verified by multiple randomized controlled studies or via large-scale meta-analyses, but it has been very effective clinically. If you are unfortunate enough to fall ill to the common cold, try Andy’s Cold Cocktail in part or all of it. If it does not work or your symptoms do not improve see a physician who will be able to better address your symptomotology.