By BitMED Provider: William Jantsch MD

Every human being on the planet is susceptible to catching a cold. The experience is annoying and frustrating, because when the illness starts, you generally know that you are going to feel miserable for several days and you hope that there is something you can do to make it better. 
A “cold” is what a doctor would call a “viral upper respiratory infection”, which is actually a whole range of conditions, caused by a fairly large number of different viruses. Depending on your age and general health status, the same virus that causes a runny nose and cough in one person may cause you to have a sore throat and a hoarse voice. 

In general, however, a cold will generally start with a feeling of body aches and fever, followed by some combination of: stuffy nose, facial pain, ears feeling plugged, sore throat, pain in the eyes with upward gaze, headache, cough, hoarse voice. 

Very commonly, the nasal stuffiness or sore throat will resolve in a day or two, then followed by a cough that will persist for up to several weeks. The alternative is also possible: an initial cough may give way to facial pressure and nasal congestion that goes on for weeks.
The general approach to treating a cold is entirely based on symptom relief. There is no scientific evidence to show that any treatment is effective in shortening or lessening the course of any viral upper respiratory infection. On the other hand, there are hundreds, if not thousands of treatments available that claim to relieve symptoms of a cold. Unfortunately, none of these works very well. 

So, what does a doctor do when a patient comes in to his office and requests help with a cold? The doctor knows that the patient is suffering from a benign, self-limiting disorder for which there is no good treatment. The patient is a wits’ end due to days of suffering with feeling unwell, and is hoping for a cure.

The prudent practitioner will attempt to accomplish two goals:
a. Reassure you that there is nothing serious needing any special attention
b. Identify and treat any other condition that may present with “cold symptoms”
The issue of antibiotics

Ever since the discovery of penicillin in the 1920’s there has been the hope of “getting something to knock this infection out”. However, now almost 100 years later, we have come to realize that antibiotics have been overused for so long that many bacteria are no longer susceptible to them. We need to stop using anti-bacterial antibiotics to treat viral infections, because there is no benefit from those antibiotics, and ultimately their overuse harms us all as a society.

An antibiotic should not be used for “just a cold”. But there are conditions that may benefit from antibiotic use that may be associated with cold symptoms, including:
a. Sinusitis
b. Pneumonia
c. Otitis media (middle ear infection)
d. Influenza
e. Streptococcal (“strep”) sore throat
Sinusitis is manifested by facial pressure, fever, and thick nasal discharge that has lasted for over a week. Most cases are still caused by viruses, but your doctor should be able to help determine if an antibiotic would be helpful.

Pneumonia usually is a complication of a viral upper respiratory infection, and the symptoms of this would include shortness of breath, high fever, chest pain, and unremitting cough. The diagnosis can be established with physical exam or with a chest x-ray.
Otitis media presents with pain and loss of hearing in an ear. There is often fever as well. Ear drainage may be present if there is a rupture of the ear drum.

Influenza (“flu”) is characterized by sudden onset of fever, muscle aches, headache, cough, and profound weakness. (It usually does not cause vomiting and diarrhea, as many people believe.) There are antiviral antibiotics that may be of some benefit if started early during the illness.
Strep throat causes sore throat, fever, and swollen glands. It does not cause cough or nasal congestion. Most sore throats are caused by viruses, and a doctor will not be able to tell for certain that you have a strep throat just by looking at you. On the other hand, a doctor may be able to tell you that strep is unlikely due to your symptoms and findings. There are rapid tests and cultures that can settle the issue. 

So, when should you see a doctor regarding your “cold”?
If you are otherwise healthy, and have no chronic medical conditions such as heart failure, diabetes, chronic lung disease, or cancer, and if you develop a cough, nasal stuffiness, sore throat, and mild muscle aches and fever, I would recommend:
a. Wait a few days and treat yourself with plenty of oral fluids, rest, and acetaminophen or ibuprofen as needed for fever or discomfort
b. If you feel better after a day or two, it is likely “just a cold”; note however, that full resolution of the nasal stuffiness, sore throat or cough may take up to 2 weeks
c. Seek medical attention if:
a. Fever is high (over 102 degrees Fareinheit) and associated with headache and weakness
b. Cough gets progressively worse over several days, and becomes associated with fever, chest pain and trouble breathing
c. Facial pain and nasal stuffiness persist for more than 10 days
d. Severe ear or throat pain