Paracetamol and ibuprofen are the only drug treatments recommended for the common cold. Extrapolated evidence taken from similar illnesses, together with the good safety profile of these drugs, suggests that paracetamol or ibuprofen is a suitable first-line treatment for the common cold and upper respiratory tract infection.

• The efficacy of analgesics has not been extensively studied, mainly because they have been used for many decades and, in the case of aspirin and paracetamol, they were used as over-the-counter (OTC) drugs before regulatory bodies required evidence from randomized controlled trials (RCTs) for licencing. CKS could find no systematic reviews to support their use in cases of common cold, nor could another review group [Arroll, 2006]. However, a comprehensive non-systematic review on the evidence for use of aspirin, paracetamol, and ibuprofen in the common cold has been reported, and provides good evidence to support their use [Eccles, 2006].
• Aspirin is not generally recommended in the common cold. Although it is a component of many OTC products, it has significantly more adverse effects compared with paracetamol or ibuprofen. In particular, it should not be used in children younger than 16 years of age because of the risk of Reye's syndrome.
• Paracetamol is usually used as first-line treatment of the common cold and is suitable in adults, children, elderly people, and pregnant women.
• Evidence for effectiveness in adults. The evidence for effectiveness of paracetamol is mainly extrapolated from its use in other conditions, such as headache, toothache, dysmenorrhoea, and post-surgical pain. Three of the most relevant trials found that paracetamol was effective in relieving pain in sore throat associated with upper respiratory tract infection. One of these RCTs also found that paracetamol reduced fever, headache, myalgia, and general discomfort.
• Evidence for effectiveness in children comes mainly from a systematic review which compared the efficacy of paracetamol with ibuprofen in reducing fever in various conditions [Perrott et al, 2004].
• Ibuprofen is a good alternative to paracetamol and has a longer duration of effect. It is less suitable for pregnant women and elderly people.
• Evidence for effectiveness in adults. Ibuprofen has a dose–response effect on pain relief in quantities up to 400 mg that lasts up to 6 hours. In particular, one RCT showed that ibuprofen reduced symptom severity and fever in patients with upper respiratory tract infection.
• Evidence for effectiveness in children. Ibuprofen has been shown to be as effective as paracetamol in several comparative RCTs.
• The safety and adverse effects of paracetamol and ibuprofen have been recorded from the accumulated data from numerous reports; including RCTs, cohort studies, and observational studies.
• Paracetamol is safe when taken correctly at standard doses. However, it is hepatotoxic in overdose, and it should be used with caution in people who have an excessive alcohol intake.
• Ibuprofen is less dangerous in overdose but is more likely to cause gastrointestinal adverse effects, some of which can be severe or life threatening (e.g. perforating ulcer). These effects are unlikely to occur with short-term use. Hypersensitivity reactions (e.g. asthma, rhinitis, angio-oedema, or urticaria) and renal problems are more likely to occur with ibuprofen than paracetamol.
• Neither paracetamol nor ibuprofen have a negative effect on the immune system or the natural duration of the common cold.
• The author concluded that paracetamol and ibuprofen are both suitable first-line treatments for the common cold. Although the evidence to support a preference for one over another was poor, it was suggested that the analgesic should be chosen according to the suitability of the individual (e.g. avoid ibuprofen in people with gastrointestinal problems, or avoid paracetamol if the person has known problems with alcohol).
• The evidence for the use of nonsteroidal anti-inflammatory drugs in the common cold is the subject of a forthcoming Cochrane review [Kim et al, 2007].