Common cold and acute upper respiratory tract infection

Essential Evidence

Last Updated on 2022-09-28 © 2022 John Wiley & Sons, Inc.

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Scott E. Nass, MD, MPA, FAAFP, AAHIVS, Director of Inpatient Education, Citrus Valley Health Partners
Aaron J. Morgan, MD, Associate Professor, New Jersey Medical School
David M. Wong, DO, Associate Program Director, Family Medicine Residency, Arrowhead Regional Medical Center

Kenny Lin, MD, MPH, Professor of Family Medicine, Georgetown University
Mindy A. Smith, MD, MS, Clinical Professor, Department of Family Medicine, Michigan State University

Overall Bottom Line

  • The diagnosis of upper respiratory tract infection (RTI) is based on clinical signs and symptoms. This is an acute infection that is typically viral in origin and in which sinus, pharyngeal, and lower airway symptoms are present, but not prominent. B
  • Antibiotics are ineffective for the treatment of the common cold in children and adults. Delayed prescriptions greatly reduce the likelihood of antibiotic consumption and reduce the likelihood of return visits as well, compared to immediate prescriptions.A
  • Antihistamines early in symptom course and multiple doses of decongestants may provide symptom relief in adults. B
  • The mean duration of illness is 7 to 14 days; most patients feel better within the first week. However, cough may persist for up to 3 weeks.C


Nonspecific upper respiratory infection (URI) is typically viral in origin and presents with symptoms that are referred to as the common cold. Clinical features include headache, sneezing, sore throat, rhinorrhea, malaise, and cough.


  • Children: 6 to 8 common colds per year.
  • Adults: 2 to 4 common colds per year.

Economic Impact

  • The annual cost for antibiotic prescriptions for URIs is $227 million.

Other Impact

  • The common cold causes approximately 20 million lost work days and 21 million lost school days.
  • There are 25 million ambulatory care visits annually for URIs.

Causes of the Condition

  • Rhinoviruses are the most common cause. Other viral causes include coronavirus, influenza virus, respiratory syncytial virus, parainfluenza virus, adenovirus, and enterovirus.


  • Various respiratory viruses have different mechanisms that lead to common cold symptoms.
  • Our understanding of the pathophysiology of the common cold comes from studying the rhinovirus.
  • The virus infects nasal mucosa or eyes through direct contact or aerosolized particles.
  • Infection of the nasal mucosa leads to vasodilation and increased vascular permeability, which leads to nasal obstruction and rhinorrhea.
  • Stimulation of the mucous glands also leads to rhinorrhea.
  • Inflammatory mediators contribute to malaise, headache, and myalgia.