Sedating cough

These limitations in the literature limit the ability to make confident and specific recommendations about treatments.

Newer nonsedating antihistamines are ineffective against cough.

Although hydrocodone is widely used and has been shown to effectively treat cough caused by other conditions, the drug has not been studied in patients with colds.

Topical (intranasal) and oral nasal decongestants have been shown to relieve nasal symptoms and can be used in adolescents and adults for up to three days.

Systematic reviews have shown that antibiotics have no role in the treatment of the common cold.1415 This is because antibiotics are ineffective at reducing symptom duration or severity and because of the risk of adverse gastrointestinal effects, cost of treatment, and increased resistance of bacteria to antibiotics.1415A Cochrane review showed that there is a lack of good evidence to determine the effectiveness of any over-the-counter product at reducing the frequency or severity of cough in children or adults.5 Some authors explicitly recommend against the use of these medications.1617 The American College of Chest Physicians guideline does not recommend centrally acting cough suppressants (e.g., codeine [Robitussin AC], dextromethorphan [Delsym]) for cough secondary to upper respiratory tract infection.18Despite these conclusions, two of the three studies included in the Cochrane review suggest that dextromethorphan provides a modest clinical benefit.519 One of these studies (a meta-analysis) showed a reduction in the frequency and severity of cough for persons 18 years or older without significant adverse effects.19 The average treatment difference was 12 to 17 percent in favor of dextromethorphan for cough bouts, cough components, and cough effort.19One study included in the Cochrane review showed that combination antihistamine/decongestant medications have a modest benefit but with significantly increased adverse effects.

In contrast, newer-generation, nonsedating antihistamines do not effectively reduce cough.18 Because of the conflicting evidence, physicians must weigh the risks and benefits of dextromethorphan or combination antihistamine/decongestant medications 10 Although clinical trials have reported a low incidence of minor adverse effects, anecdotal reports of serious adverse effects and dosing errors have prompted the American Academy of Pediatrics and other experts to caution against the use of these preparations in children.2124There also is little evidence to support the use of codeine and its derivative hydrocodone (Hycodan) to relieve cough caused by the common cold in adults and children.5 One small study of codeine use in children25 and two small studies in adults2627 failed to show a benefit.