Common cold
Acute self-limiting viral upper respiratory infection. Most often caused by rhinoviruses, coronaviruses, and adenoviruses. Lasts 5–10 days and does not require specific antiviral therapy. Treatment is symptomatic.
ICD-10 J0056 drugs
Also known as: Acute viral respiratory infection, Nasopharyngitis
Drugs used for this condition
- BBrivudineFirst line · Antiviral, nucleoside analogueBrivudine is EMA-approved for herpes zoster in immunocompetent adults. Comparative trials show it more effective than aciclovir for pain resolution. Once-daily for 7 days. Main limitation – strict incompatibility with 5-FU/capecitabine: 4-week washout required between brivudine and chemotherapy start.
- CAndrographis paniculataAdd-on therapy · Plant immunomodulator, supplement. In EU – traditional herbal medicinal product (EMA HMPC monograph 2013)Andrographis is one of the adaptogens with relatively more convincing evidence in the common cold. The Hu 2017 systematic review of 33 RCTs in 7175 participants showed moderate reduction in cold symptom duration and severity (cough, sore throat, nasal congestion) with andrographis extracts 1200–6000 mg/day for 5–7 days. The Cáceres 1999 RCT in 152 cold patients showed significant symptom reduction by day 4–5 with SHA-10 vs placebo. The Saxena 2010 RCT in 223 patients with KalmCold showed symptom reduction by day 2-3. Evidence quality is limited by product heterogeneity, varied andrographolide standardisation and potential publication bias. EMA HMPC 2013 recognises «traditional use». AAFP 2019 and SEIMC 2020 for the common cold list symptomatic therapy first-line; andrographis is in the «evidence limited» category.
- CParacetamol + Chlorpheniramine + PhenylephrineThird line · Symptomatic cold preparation: analgesic-antipyretic, H1-antihistamine, and sympathomimetic decongestantSymptomatic relief of cold symptoms in adults: fever, headache, muscle pain, runny nose, nasal congestion. Per SEMERGEN 2023 and Cochrane 2023, fixed cold combinations give modest short-term effect on individual symptoms; paracetamol monotherapy is more effective for pain and fever. Dose: typically 500–650 mg paracetamol + 4 mg chlorpheniramine + 10 mg phenylephrine every 4–6 hours, max 4 times daily. Course ≤3–5 days.
- CZinc (oral salts: picolinate, citrate, gluconate, oxide, acetate)Case-by-case decision · Mineral supplements. Trace elementsEvidence is mixed. The 2013 Cochrane review (Singh & Das, 18 RCTs, around 2,000 participants) in adults found a 1–1.5 day reduction in cold duration with zinc lozenges or syrup at 75 mg elemental zinc daily, started within 24 hours of symptom onset. Zinc as **prevention** (continuous intake to avoid new URI episodes) has not reproduced its effect in large RCTs. The AAP does not recommend zinc for colds in children – the modest clinical benefit does not justify side effects: nausea, unpleasant taste, diarrhoea. CDC and NICE do not include zinc in URI management standards. Intranasal zinc has been withdrawn due to irreversible smell loss.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAnaferon (anti-human interferon gamma antibodies in homeopathic dilutions)Not recommended · Homeopathic medicinesAnaferon contains antibodies to human gamma interferon in homeopathic dilutions, and it is marketed for treating and preventing acute respiratory viral infections. A clear benefit for this use has not been shown: there is no reliable evidence behind this application. For a common viral respiratory illness, rest, fluids, fever reducers when needed, and time tend to help, and most people recover within a few days. Do not use this product in place of treatment with proven benefit, since that risks missing the care you actually need.
- DAnas Barbariae Hepatis et Cordis Extractum (homeopathic)Not recommended · Homeopathic products (local classification)A homeopathic extract from duck liver and heart, promoted for the common cold and flu-like symptoms. Studies have not shown a convincing benefit for acute viral respiratory infection, and there is no solid evidence for this use. For a cold, rest, plenty of fluids, and proven remedies for fever or a runny nose ease the symptoms when needed. The substance itself does no harm in this role, but using it in place of treatment with proven benefit risks missing the care you actually need.
- DAscorbic acidNot recommended · Vitamins. AntioxidantsThe 2013 Cochrane review (29 RCTs, more than 11,000 participants) showed that regular vitamin C 200 mg daily or higher in the general population does not reduce respiratory infection incidence. In athletes under extreme physical stress, the risk drops by 50% with daily intake. In most adults, routine vitamin C for cold prevention has no proven benefit. Symptom duration reduction when started after onset is about 8% in adults – minimal clinical significance.
- DAzoximer bromideNot recommended · Other immunostimulants (local classification)Polyoxidonium for viral URI and influenza in adults and children is not mentioned in international guidelines. WHO, IDSA, NICE, and AAP do not include it in viral infection standards. Standard URI care is symptomatic. Influenza-specific therapy: neuraminidase inhibitors (oseltamivir, zanamivir) and baloxavir; for COVID-19: nirmatrelvir/ritonavir in high-risk outpatients.
- DBenzydamineNot recommended · Non-steroidal anti-inflammatory agent for topical use in the mouth and throatThroat lozenge advertising promises to «beat the cold faster». Benzydamine does not shorten a cold. It relieves throat pain, while the runny nose, cough, fever and general wipe-out run their course: a viral upper respiratory infection lasts 5 to 10 days whether or not lozenges are sucked. The 2014 Cochrane review of over-the-counter cough medicines and the 2015 review of antihistamines for the common cold show the same thing – pharmacy cold remedies either have no effect or one so small that the patient does not notice it. In pediatrics, Spanish authors in Anales de Pediatría 2022 described the other side: cold remedies cause poisonings and show no benefit in children. Sensible management of a cold is simple – fluids, rest, paracetamol or ibuprofen as needed. If lozenges are sold as a way to «cure a cold in three days», consider seeking a second opinion.
- DBeta-1,3/1,6-D-glucan (yeast or oat)Not recommended · Polysaccharide immunomodulator. Oat beta-glucan is a dietary fibre with EFSA-approved cholesterol health claim. Yeast beta-glucan (Wellmune) is a supplement with immunity marketing without EFSA approvalYeast beta-glucan is sold as a «natural cold remedy» promising symptom duration and severity reduction. Talbott 2009 and Auinger 2013 RCTs showed moderate cold symptom reduction with Wellmune 250 mg/day, but the effect did not exceed clinically significant threshold and depended on population (marathoners, healthy volunteers, not patients with active cold). EFSA 2013 and 2014 rejected the health claim. No Cochrane systematic review on beta-glucan in the common cold. AAFP 2019 and SEIMC 2020 for the common cold list symptomatic therapy first-line (paracetamol, nasal irrigation, rest, fluids); beta-glucan is not mentioned. If beta-glucan was recommended as a substitute for symptomatic therapy or antibiotic in bacterial superinfection, consider seeking a second opinion.
- DBromelain (pineapple enzyme)Not recommended · Proteolytic enzyme from Ananas comosus pineapple stem and fruit. EU registered NexoBrid (concentrate of proteolytic enzymes enriched in bromelain, EMA 2012) for enzymatic deep burn excision topical. Oral – supplement. AEMPS registered NexoBrid for specialised burn centre useBromelain is sold as a «natural common cold remedy», «cold duration reducer» and «anti-inflammatory throat shield». Adult cold evidence base is limited: no Cochrane bromelain systematic reviews on cold. Cochrane vitamin C cold review (Hemilä 2013) showed moderate symptom duration reduction in regular users; no comparable bromelain data. AAFP, NICE, SEIMC for cold recommend symptomatic therapy: paracetamol for fever, fluids, rest, saline nasal irrigation; bromelain is not in guidelines. In patients on antiplatelets and anticoagulants bleeding risk is increased. If bromelain is self-taken for cold instead of family physician consultation for prolonged symptoms (>10 days), persistent high fever, dyspnoea, purulent discharge, consider seeking a second opinion.
- DElderberry (Sambucus nigra)Not recommended · Plant immunomodulator, supplement. In EU – traditional herbal medicinal product (EMA HMPC monograph on flowers, berries classified as food)Black elderberry is widely sold as a «natural cold remedy» promising to shorten URI duration. The Hawkins 2019 meta-analysis in 180 patients across 4 RCTs showed moderate 2–4 day symptom duration reduction with Sambucol syrup started in the first hours of illness. Evidence quality is limited by small samples, heterogeneous methods and potential conflicts of interest (some trials sponsored by the manufacturer). The updated Cochrane 2024 review on flu and cold rated the data as mixed evidence: small effect, uncertain clinical relevance. AAFP 2019 and SEIMC 2020 for the common cold list paracetamol for fever, fluids, rest, nasal saline irrigation first-line; elderberry is not in international guidelines. If elderberry was recommended as a substitute for symptomatic therapy or for antibiotic in bacterial superinfection, consider seeking a second opinion.
- DErgoferon (antibodies to γ-interferon, CD4, and histamine in homeopathic dilutions)Not recommended · Homeopathic preparation marketed as an immunomodulator (local classification)Ergoferon combines antibodies to gamma-interferon, CD4, and histamine in homeopathic dilutions. The manufacturer markets it as an antiviral and immune-modulating remedy for acute respiratory viral infection. No convincing benefit has been shown for this use, and there is no quality evidence base behind it for the common cold or flu. For these infections, supportive care usually helps – rest, fluids, and symptomatic relief for fever and congestion; for influenza, a doctor may prescribe agents with proven antiviral activity when indicated. The substance is harmless in this role, but do not take it instead of treatment with proven benefit, so you do not miss the care you need.
- DFlurbiprofenNot recommended · Non-steroidal anti-inflammatory drug, propionic acid derivative, for topical throat treatmentThe «cold remedy» positioning of flurbiprofen lozenges rests on a feeling: the throat stopped hurting, so treatment must be working. The product does not affect the duration of a cold. The 2014 Cochrane review of over-the-counter cough medicines found no convincing data in favor of pharmacy cold remedies in adults or children, and the Spanish Guía-ABE chapter on upper respiratory catarrh states plainly that no such drug provides meaningful symptom relief. There is also an age limit: throat flurbiprofen is contraindicated in children under 12. A cold resolves in 5 to 10 days and no lozenge speeds that up – it is there precisely to make the pain easier to bear. If flurbiprofen was recommended as a course «so you do not fall ill», consider seeking a second opinion.
- DGuaifenesinNot recommended · ExpectorantGuaifenesin sits in cold powders and syrups alongside paracetamol, phenylephrine and dextromethorphan. These kits sell as an all-symptoms-at-once remedy, yet each component treats its own symptom and rarely are all of them needed together. The 2014 Cochrane review of over-the-counter medicines for acute cough found no convincing evidence of benefit for expectorants or for combinations. The practical problem with combinations lies elsewhere: a cough suppressant often stands next to guaifenesin, and the AEMPS label calls that pairing illogical outright, because it blocks expectoration. The second risk is the paracetamol inside: someone takes the sachet and a separate antipyretic, and the daily dose is exceeded without notice. In children under 2 these products are contraindicated.
- DIvy leaf dry extract (Hedera helix)Not recommended · Herbal expectorant«A herbal syrup at the first sign of a cold» sounds harmless, yet ivy does not shorten a cold. The updated systematic review by Sierocinski and colleagues (Eur J Clin Pharmacol 2021) on ivy preparations in acute upper respiratory infections found few trials and low-quality evidence, and the Spanish Guía-ABE chapter on upper respiratory catarrh says plainly that pharmacy cold remedies do not relieve symptoms meaningfully. Herbal origin guarantees no safety: the AEMPS ficha técnica bans the syrup under 2 years because of the risk of worsening respiratory symptoms and asks for a diagnosis in children aged 2 to 4 with lingering cough. If ivy syrup was advised as a course «to prevent colds», consider seeking a second opinion.
- DKagocelNot recommended · Other antivirals (local classification)Kagocel is marketed as an antiviral for colds and flu, with claims that it boosts the body's own interferon. It hasn't shown convincing benefit for these infections, and there's no solid evidence base for this use. A cold or flu usually clears on its own within a few days, and supportive care helps most: fluids, rest, and a fever reducer if needed. For severe flu or a high risk of complications, ask your doctor about antivirals with proven effectiveness.
- DLicorice root (Glycyrrhiza glabra, root and rhizome; including deglycyrrhizinated DGL)Not recommended · Root of Glycyrrhiza glabra and related Glycyrrhiza uralensis and Glycyrrhiza inflata species. Supplements come as root extract, candy, tea, alcoholic tincture, and deglycyrrhizinated form (DGL, without glycyrrhizin). Marketing promotes licorice as «adrenal support», a remedy for «adrenal fatigue», and a «natural remedy for viruses and gastritis». EMA HMPC published a European herbal monograph (2013) with traditional uses in cough, dyspepsia, and skin irritation; AEMPS does not register it as a medicine; AESAN classifies it as a complemento alimenticio. FDA grants GRAS status as a food additive but in 2017 warned consumers of cardiac arrhythmia risk with intake above 56 g/day of black licorice candy in people over 40.Licorice for colds and cough appears in the EMA HMPC monograph 2013 as a «traditionally used herb», which is a regulatory category recognising 30 years of folk use, not proven clinical efficacy. Modern RCTs with hard endpoints (illness duration, complications, viral load) are absent. Cochrane has not published a systematic review of licorice root in cold or upper respiratory infection. NICE and the Spanish SEMI recommend symptomatic therapy in uncomplicated cold: paracetamol for fever, fluids, rest, humidified air; antibiotics are not indicated, antivirals only in influenza and COVID-19 in high-risk patients (oseltamivir, nirmatrelvir/ritonavir). Licorice does not appear in these recommendations. Licorice syrup in Russia is registered in GRLS as an expectorant for cough with viscous sputum for short-term use (5–7 days). EMA HMPC limits courses to 4–6 weeks and glycyrrhetinic acid intake to 100 mg/day.
- DPropolis (bee product)Not recommended · Bee product, supplement. Not registered as monomedicine in EU or AEMPS; OTC segment in Italy and GermanyPropolis is sold as a «natural antibiotic» for colds and sore throat. Evidence base is weak: small RCTs showed heterogeneous results with propolis lozenges and sprays for pharyngitis symptom relief, without confirming symptom duration or complication frequency reduction. IDSA 2016 and AAFP list symptomatic therapy (paracetamol, fluids, rest) first-line for the common cold; efficacy of supplements including propolis is not confirmed. If propolis was recommended as a substitute for a medical consultation in prolonged infection (>10 days) or bacterial sinusitis/tonsillitis symptoms, consider seeking a second opinion.
- DPseudoephedrineNot recommended · Systemic decongestant, sympathomimeticSpanish «flu powders» – Frenadol, Pharmagrip, Gelocatil Gripe – are sachets and capsules where pseudoephedrine sits next to paracetamol, dextromethorphan and chlorphenamine. They do not shorten a cold. The 2012 Cochrane review rates such combinations as giving small benefit to adults and finds no benefit at all in young children. The risk meanwhile adds up across every component: paracetamol is easy to overdose when also taken separately, chlorphenamine causes drowsiness, and pseudoephedrine raises blood pressure and disturbs sleep. Spanish toxicologists in Anales de Pediatría 2022 described child poisonings with exactly these products. What works in a cold is rest, fluids and a painkiller as needed in a dose you can count. If a flu combination with pseudoephedrine was prescribed to a child or advised for a week, consider seeking a second opinion.
- DSodium deoxyribonucleate (Derinat)Not recommended · Immunomodulators (local classification). Russian development.Sodium deoxyribonucleate (Derinat) is marketed as an immunomodulator for treating and preventing acute respiratory viral infections. No convincing benefit has been shown for this use: there is no solid evidence base for it in respiratory viral infections. These infections usually clear on their own within a few days, and what actually helps is supportive care – rest, fluids, and symptom relief when needed. The substance is harmless in this role, but it should not replace an approach with proven benefit, since that risks missing the treatment a person needs.
- DUmifenovirNot recommended · Other antiviralsUmifenovir is an antiviral promoted for treating and preventing acute respiratory viral infections. Convincing benefit for this use has not been shown: there is no solid evidence that it changes the course or outcome of a common respiratory infection. For an ordinary cold, supportive care helps – rest, fluids, and symptom-relief measures when needed.
- FAmoxicillinNot recommended · Penicillins with extended spectrumAmoxicillin is not indicated for the common cold: the infection is viral. In the Cochrane review (2025 version, literature search up to 2013; 6 RCTs) antibiotics did not reduce the proportion of patients with persisting symptoms compared with placebo (RR 0.83; 95% CI 0.60–1.14), while adverse events increased (RR 1.8; 1.01–3.21), in adults RR 2.62 (1.32–5.18), with no difference in children. There is no evidence that an antibiotic prevents bacterial complications. ACP/CDC 2016 advise against prescribing antibiotics for the common cold, partly because of rising resistance. Per the label, Amoxicillin is contraindicated in penicillin allergy and after anaphylaxis to another beta-lactam; common adverse reactions are diarrhoea and nausea, rash occurs, and antibiotic-associated colitis is rare. In infectious mononucleosis, easily mistaken for a cold with sore throat, Amoxicillin often causes a rash. If symptoms last more than 10 days, return after improvement, or ear pain, breathlessness or high fever appear, it is reasonable to discuss with a doctor whether a bacterial complication is present: in sinusitis, otitis or pneumonia Amoxicillin may be indicated.
- FAmoxicillin + Clavulanic AcidNot recommended · Fixed-dose combination: aminopenicillin plus beta-lactamase inhibitorFor the common cold, amoxicillin-clavulanate does not help. Per Cochrane 2025 (Kenealy and Arroll; literature search to 2013), antibiotics do not speed recovery (RR of no cure 0.83, 95% CI 0.60–1.14, 6 RCTs), there is no evidence that they prevent complications, and adverse effects are more frequent (RR 1.8; in adults RR 2.62, 95% CI 1.32–5.18; no increase in children). The authors do not recommend routine use. The harm of the combination is documented in the Spanish SmPC: antibiotic-associated diarrhea including C. difficile colitis, candidiasis, allergic reactions up to severe ones, and cholestatic hepatitis, which may appear after the course has ended; a history of jaundice or liver injury with the drug is a contraindication (4.3). Prescribing "just in case" also selects resistant strains. Reassessment is needed if symptoms last more than 10 days without improvement, there is fever ≥39 °C with purulent nasal discharge for at least 3 consecutive days, or worsening after improvement: these are the criteria for bacterial rhinosinusitis (IDSA 2012). If it was prescribed for a runny nose, a common cold, or a mild cough shorter than 7 days without other signs, it is reasonable to discuss the prescription with your doctor.
- FApixabanNot recommended · Direct oral anticoagulants (factor Xa inhibitors)After the COVID-19 pandemic some patients took up the habit of taking apixaban, rivaroxaban, and other DOACs at the first symptoms of an upper respiratory infection «for blood thinning and thrombosis prevention». International guidelines do not support this. Outpatient viral URI is self-limiting, clinically meaningful thromboembolism risk is not elevated, and major bleeding risk on apixaban remains the same. WHO, NICE, ASH, and ISTH do not mention anticoagulants for outpatient URI. Evidence-based management is rest, hydration, symptomatic measures; antivirals (oseltamivir, nirmatrelvir/ritonavir) are reserved for confirmed influenza or COVID-19 in high-risk patients.
- FAzithromycinNot recommended · MacrolidesAzithromycin is prescribed for upper respiratory infections, influenza and mild COVID-19 without bacterial complication. WHO AWaRe 2024 states that antibiotics do not act on viruses and are not indicated for viral URIs. The PRINCIPLE (Butler, 2021), ATOMIC2 (Hinks, 2021), COALITION II (Furtado, 2020) and Cavalcanti (2020) RCTs did not show azithromycin benefit in COVID-19. QT prolongation risk applies (FDA Drug Safety Communication 2013).
- FBudesonideNot recommended · Inhaled corticosteroids (ICS)Inhaled budesonide for viral URI in patients without underlying asthma or COPD is not supported by international guidelines. NICE, CDC, BMJ Best Practice, and AAP do not include ICS in cold treatment standards. Self-prescribing Pulmicort «for cough» in adults and children is common in Russia and the CIS and frequently delays correct diagnosis and adds unjustified glucocorticoid exposure.
- FCefditoren pivoxilNot recommended · Third-generation oral cephalosporinCefditoren pivoxil is prescribed for acute pharyngitis and upper respiratory infections without confirmed bacterial etiology. WHO 2024 AWaRe places oral third-generation cephalosporins in the Watch category. NICE NG191 2020 does not recommend antibiotics for acute bronchitis in immunocompetent adults. The AEMPS Ficha Técnica confines cefditoren to confirmed GAS tonsillopharyngitis, chronic bronchitis exacerbation, uncomplicated pneumonia and skin infections.
- FCeftriaxoneNot recommended · Third-generation cephalosporinsCeftriaxone is used in outpatient settings for upper respiratory infections and mild COVID-19 as a fallback. WHO 2024 AWaRe places ceftriaxone in the Watch category, recommending limited inpatient use. NICE NG191 2020 and IDSA 2019 do not include ceftriaxone in outpatient URI standards. Intramuscular pediatric use without bacterial confirmation drives irrational use and resistance.
- FCefuroxime axetilNot recommended · Second-generation oral cephalosporinCefuroxime axetil is prescribed for upper respiratory infections, acute bronchitis and uncomplicated pharyngitis without group A streptococcal confirmation. WHO 2024 AWaRe limits outpatient oral cephalosporin use. NICE NG191 2020 does not recommend antibiotics for acute bronchitis in immunocompetent adults. Use in viral infections is irrational.
- FCetirizineNot recommended · Second-generation antihistaminesCetirizine is not effective for the common cold. The 2015 Cochrane review «Antihistamines for the common cold» (15 RCTs, 5,099 participants) showed that second-generation H1 antagonists (cetirizine, loratadine) do not reduce nasal symptoms. A weak effect on rhinorrhoea is seen only with first-generation H1 agents (chlorpheniramine, diphenhydramine) via their anticholinergic component, which cetirizine largely lacks. AAP, NICE, and CDC do not recommend antihistamines for the common cold. Widespread prescribing in post-Soviet practice is inconsistent with international evidence.
- FChloropyramineNot recommended · First-generation H1 antihistamine, ethylenediamine derivativeChloropyramine often gets added to cold treatment, on the expectation that it dries a runny nose and relieves nasal swelling. The 2015 Cochrane review pooled 18 trials and 4342 participants and found this: in adults antihistamines give a small short-lived effect on overall symptom severity on day one or two, by day three the difference disappears, and there is no effect on nasal congestion, sneezing or rhinorrhoea taken separately. In children even that did not appear. Adverse effects, meanwhile, were markedly more frequent than on placebo, sedation first among them. Colds are caused by viruses rather than histamine, and a dried mucosa performs its barrier job worse. If chloropyramine was prescribed as treatment for a viral respiratory infection, consider seeking a second opinion.
- FCiprofloxacinNot recommended · Fluoroquinolone antibacterialsCiprofloxacin is prescribed for upper respiratory infections, bronchitis and as a fallback for viral illnesses. WHO 2024 AWaRe and ESCMID 2020 strictly confine fluoroquinolones to serious infections. The 2018 EMA PRAC and FDA Drug Safety Communication 2016 cited tendon damage, peripheral neuropathy and aortic aneurysm risk; an FDA boxed warning restricts use in uncomplicated UTIs and sinusitis to cases without alternatives.
- FCloperastineNot recommended · Cough suppressant with central and peripheral actionCough syrup for a child with a cold is the most habitual autumn purchase in a Spanish pharmacy. Cloperastine is contraindicated under 2 years directly in the AEMPS ficha técnica. The numbers then speak for themselves: Spanish toxicologists in Anales de Pediatría 2022 analyzed child poisonings with cold remedies and showed that their benefit is unproven while the toxicity is real. The Guía-ABE chapter on upper respiratory catarrh puts it the same way: none of these drugs relieves symptoms meaningfully. The 2018 Cochrane review of honey for acute cough in children found data no worse than for pharmacy syrups – honey over the age of one reduces cough frequency. In a child's cold what works is fluids, saline nasal rinsing and time. If cough syrup was prescribed to a child under 2, consider seeking a second opinion from a pediatrician.
- FCo-trimoxazoleNot recommended · Sulfonamide-trimethoprim combinationFor acute viral upper respiratory infection and uncomplicated common cold, co-trimoxazole is not prescribed. The antibiotic does not shorten symptom duration or prevent bacterial complications, while carrying risks of rash, hematologic complications, and selection of resistant strains. "Just-in-case" prescribing for URI is an example of irrational antibiotic use.
- FDoxycyclineNot recommended · TetracyclinesDoxycycline is used for upper respiratory infections, influenza and mild COVID-19 without confirmed bacterial coinfection. WHO 2024 AWaRe and NICE NG191 2020 do not recommend antibiotics in URIs. The PRINCIPLE 2021 (Butler) trial did not show doxycycline benefit in outpatient COVID-19. Teratogenicity (FDA category D) and photosensitivity in children under 8 add risk.
- FEchinacea purpurea (juice/extract)Not recommended · Herbal immunomodulators (local classification)The 2014 Cochrane review (Karsch-Völk et al., 24 RCTs, over 4,600 participants) concluded that convincing evidence for echinacea in cold prevention or symptom reduction is lacking. Some studies show a borderline effect, but methodological heterogeneity and risk of bias preclude a general conclusion. WHO, NICE, and AAP guidelines do not list the product.
- FFosfomycinNot recommended · Other antibacterialsFosfomycin tromethamine is prescribed as a broad-spectrum fallback in respiratory viral infections. WHO 2024 AWaRe and IDSA 2024 confine fosfomycin to uncomplicated UTIs and outpatient bacteriuria prophylaxis in pregnancy. Use in upper respiratory infections, bronchitis or pneumonia is not indicated: oral fosfomycin achieves meaningful concentrations only in urine.
- FInosine pranobexNot recommended · Other antivirals with claimed immunostimulant effectFor URI, isoprinosine is absent from WHO, NICE, AAP, and IDSA guidelines. Baseline URI care is symptomatic; aetiotropic therapy is not needed except for confirmed influenza in high-risk patients (oseltamivir) and COVID-19 in high-risk patients (nirmatrelvir/ritonavir).
- FInterferon alpha-2b (nasal formulations)Not recommended · Other topical nasal preparations (local classification)Nasal interferon formulations for URI are not mentioned in international guidelines (WHO, CDC, IDSA, NICE). URI is a self-limited viral illness that does not require etiotropic therapy. Symptomatic care and adequate hydration are the only approach supported by international guidelines.
- FInterferon α-2b in suppositoriesNot recommended · Interferons (suppositories, local classification)Rectal interferon α-2b in viral URI in adults and children is not mentioned in WHO, NICE, AAP, or CDC guidelines. The rectal form's efficacy in URI has not been independently evaluated. Foundation: symptomatic URI care.
- FIpratropium bromideNot recommended · Short-acting muscarinic antagonist for inhalation (SAMA)Ipratropium is sold as nasal drops (Atrovent Nasal) for «rhinorrhea in colds» – marketing by symptom, not aetiology. Quality RCTs in acute infectious rhinitis show no clinically meaningful benefit: rhinorrhea shortens by 1–2 days without impact on cold duration or complication risk. AEMPS keeps intranasal ipratropium only for vasomotor rhinitis. If intranasal ipratropium is suggested «for a cold», consider seeking a second opinion.
- FLevofloxacinNot recommended · Third-generation fluoroquinoloneLevofloxacin is prescribed for bronchitis, upper respiratory infections and presumed pneumonia without radiographic confirmation. WHO 2024 AWaRe and IDSA 2019 confine fluoroquinolones to serious infections. The 2018 EMA PRAC and FDA boxed warning curtailed routine use due to tendinopathy, peripheral neuropathy and aortic aneurysm risk. Use in viral infections is not indicated.
- FLoratadineNot recommended · Second-generation antihistaminesLoratadine does not work for the common cold. The 2015 Cochrane review «Antihistamines for the common cold» showed second-generation H1 antagonists do not improve cold symptoms. Only first-generation H1 drugs show a weak effect through their anticholinergic action, which loratadine largely lacks. AAP, NICE, and CDC do not include antihistamines in common cold recommendations. Widespread use in post-Soviet countries is inconsistent with the evidence base.
- FMeglumine acridone acetateNot recommended · Other immunostimulants (local classification)URI resolves spontaneously. Symptomatic care is the only approach supported by international guidelines. 'Immunomodulator' drugs are not part of this list.
- FMethotrexateNot recommended · Antimetabolites, folic acid analoguesUse of methotrexate in viral URI or cold is not described in any international source. The drug is an immunosuppressant with a serious side-effect profile; use outside rheumatologic, dermatologic, gastrointestinal, or oncologic indications is unacceptable.
- FMetronidazoleNot recommended · Imidazole derivatives (antiprotozoal / antibacterial)Metronidazole is not used in viral URI. The drug does not act on viruses or aerobic flora and is not mentioned in international URI guidelines. Common Russian prescriptions for «antibiotic-associated dysbiosis» or in «frequently ill children» are not justified by evidence.
- FMoxifloxacinNot recommended · Fourth-generation fluoroquinoloneMoxifloxacin is prescribed for upper respiratory infections, influenza and atypical persistent cough without bacterial confirmation. WHO 2024 AWaRe and IDSA 2019 confine fluoroquinolones to serious infections without alternatives. The 2018 EMA PRAC and FDA Drug Safety Communication 2018 additionally cited QT prolongation and aortic aneurysm risk. Use in viral infections is irrational.
- FOxymetazolineNot recommended · Topical nasal vasoconstrictor, imidazoline derivativeNose drops for a child with a cold look harmless, which is exactly why they are bought most often. Oxymetazoline is banned under 6 years: the AEMPS ficha técnica states that children are especially prone to systemic absorption of the substance and to its adverse reactions, up to profound central nervous system depression with overdose, too frequent or prolonged use. Spanish toxicologists in Anales de Pediatría 2022 showed the same picture from another side: cold remedies in children cause poisonings and bring no proven benefit. The Guía-ABE chapter on upper respiratory catarrh puts it plainly: none of these drugs relieves symptoms meaningfully. What helps a child with a cold is saline rinses, humid air and time. If vasoconstrictor drops were prescribed to a child under 6, consider seeking a second opinion from a pediatrician.
- FPrednisoloneNot recommended · GlucocorticoidsPrednisolone and other systemic corticosteroids are not used for acute viral upper respiratory infections in any international guideline (WHO, NICE, IDSA, CDC, BMJ Best Practice). A viral infection without bacterial complication resolves in 5–10 days on its own. Systemic corticosteroids do not suppress the virus; they suppress the immune response and prolong viral shedding. Self-prescribed prednisolone «to recover faster» carries risks of secondary bacterial infections, hyperglycaemia, ulcer complications, and withdrawal syndrome on abrupt discontinuation.
- FRifampicinNot recommended · Antituberculous antibioticFor acute uncomplicated viral upper respiratory infection, rifampicin is not prescribed. An antimycobacterial agent with a long list of significant drug interactions (CYP3A4/CYP2C9 induction) is used only under strict indications. Prescribing rifampicin for URI is an example of irrational therapy and increases the risk of selecting rifampicin-resistant M. tuberculosis strains in the population.
- FRivaroxabanNot recommended · Direct oral anticoagulants (factor Xa inhibitors)After the COVID-19 pandemic some patients took up the habit of taking rivaroxaban, apixaban, and other DOACs at the first symptoms of an upper respiratory infection «for thrombosis prevention». International guidelines do not support this. Outpatient viral URI is self-limiting, clinically meaningful thromboembolism risk is not elevated, and major bleeding risk on rivaroxaban remains the same. WHO, NICE, ASH, and ISTH do not mention anticoagulants for outpatient URI. Evidence-based management is rest, hydration, symptomatic measures; antivirals (oseltamivir, nirmatrelvir/ritonavir) are reserved for confirmed influenza or COVID-19 in high-risk patients.
- FSalbutamol (Albuterol)Not recommended · Short-acting beta-2 adrenergic agonists (SABA)Salbutamol is not mentioned in international guidelines for viral URI without bronchospasm. A 2014 Cochrane review found no benefit in children with acute bronchitis without wheezing. Use in patients without airflow obstruction produces only tachycardia and tremor with no clinical benefit.
- FTiloroneNot recommended · Other antivirals (local classification)Viral URI is a self-limited illness that does not require etiotropic therapy. International guidelines support only symptomatic care: antipyretics for fever, adequate hydration, and rest. Tilorone is not considered for this purpose in international sources.
- FTranexamic acidNot recommended · Antifibrinolytics, amino acidsTranexamic acid in viral URI and sore throat is not mentioned in international guidelines. Common Russian use of nebulized tranexamic acid in pediatric stenotic laryngotracheitis is not supported by evidence – Cochrane reviews do not confirm efficacy. Croup standard care: nebulized epinephrine and systemic corticosteroids (dexamethasone, budesonide).
- FVitaglutamNot recommended · Other antivirals (local classification)URI does not require etiotropic therapy. Symptomatic care and self-limitation form the backbone of international guideline recommendations.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit