January 21, 2025 from Medscape
Primary Care Tips for Managing the Common Cold
For most patients, upper respiratory infections (URIs) like the common cold are benign and self-limiting. In fact, mild COVID-19 cases are now often treated similarly. Still, primary care visits for cold symptoms remain common—and require careful evaluation and counseling to avoid missed diagnoses and overprescribing.
When to Bring Patients In
Many URI symptoms can be managed remotely. As guest Dr. Amber Bird noted, when a patient exchanges more than a couple of portal messages, “that’s when she says, ‘Just come in.’” Otherwise, a single question—especially from a healthy, low-risk patient—can often be answered via portal.
If a patient does come in, vital signs are crucial. A normal temperature, heart rate, respiratory rate, and oxygen saturation can significantly reduce concern. However, a physical exam helps not only to rule out pneumonia or sinusitis, but also to validate the patient’s experience.
“You want to make sure that you’re not anchoring to the common cold and missing something a little bit more sinister,”
said Dr. Paul Williams. During cold season, it’s easy to assume symptoms are minor without a full evaluation.
Testing and Isolation Guidance
Patients frequently ask about strep, flu, or COVID tests. These may not alter treatment but can inform isolation or return-to-work guidance—particularly if patients live with immunocompromised individuals or work in healthcare.
Isolation recommendations are now unified across all URIs: patients can resume normal activity once they’ve been fever-free for 24 hours and are generally improving. However, masking and maintaining distance for five days is still considered common courtesy.
Counseling for Symptoms That Linger
Effective cold care includes reassurance.
“These infections tend to be self-limited,”
said Williams, typically lasting five to seven days. However, patients may not expect the lingering cough that often follows. On average, post-viral cough can persist for 18 days, and patients should be warned so they don’t become alarmed.
Targeting Treatment to Symptoms
Treatment for URIs remains symptom-focused. Physicians often ask which symptom is most bothersome and tailor care accordingly.
For sinus congestion, intranasal steroids like fluticasone, saline rinses, or short-term use of nasal decongestants may help. Oral phenylephrine, however, has little evidence of effectiveness and may soon be removed from shelves.
Cough treatment options include dextromethorphan and benzonatate, though neither has strong evidence. Williams emphasized that benzonatate can be dangerous if ingested by children and should be securely stored. Guaifenesin may also be used, but its benefits are anecdotal.
When to Consider Antibiotics
Antibiotics are typically unnecessary unless a patient has “double sickening”—initial improvement followed by worsening symptoms—or has persistent issues beyond 7–10 days. In those cases, a five-day course of amoxicillin is standard, with doxycycline as an alternative for penicillin-allergic patients.
Conquering Colds
Treating the common cold may seem routine, but thoughtful evaluation, clear communication, and symptom-based care go a long way. When done well, it reassures patients, prevents complications, and builds trust—one stuffy nose at a time.
Considering an IME or document review to resolve an insurance claim, legal file, or workplace health and safety issue?
Our specialists provide evidence-based opinions, so get in touch with Western Medical today to learn more about our services.