Oral Antihistamine-Decongestant-Analgesic Combinations for the Common Cold

The quality of evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in design, participants, interventions and outcomes).

A Cochrane review [Abstract] 1 included 30 studies with a total of 6304 participants with common cold. The control intervention was placebo in 26 trials and an active substance (paracetamol, chlorphenindione + phenylpropanolamine + belladonna, diphenhydramine) in six trials. The trials took place in different settings: university clinics, paediatric departments, family medicine departments, and general practice surgeries.

• Antihistamine-decongestant: 14 trials (1298 participants). The OR of treatment failure was 0.31 (95% CI 0.20 to 0.48); NNTB 3.9 (95% CI 3.03 to 5.2). On the final evaluation day (follow-up: 3 to 10 days), 55% of participants in the placebo group had a favourable response compared to 70% on active treatment. Adverse effects: the antihistamine-decongestant group experienced more adverse effects than the control group: 128/419 (31%) versus 100/423 (13%) participants suffered one or more adverse effects (OR 1.58, 95%CI 0.78 to 3.21).
• Antihistamine-analgesic: 4 trials (1608 participants). The OR of treatment failure was 0.33 (95% CI 0.23 to 0.46); NNTB 6.67 (95% CI 4.76 to 12.5). 43% of participants in the control group and 70% in the active treatment group were cured after six days of treatment. Adverse effects: there were not significantly more adverse effects in the active treatment group compared to placebo (drowsiness, hypersomnia, sleepiness 10/152 versus 4/120); OR 1.64 (95 % CI 0.48 to 5.59).
• Analgesic-decongestant: 7 trials (2575 participants). One trial reported on global effectiveness: 73% of participants in the analgesic-decongestant group reported a benefit compared with 52% in the control group (paracetamol) (OR of treatment failure 0.28, 95% CI 0.15 to 0.52; NNTB 4.7).Adverse effects: the decongestant-analgesic group experienced significantly more adverse effects than the control group (199/1122 versus 75/675); OR 1.62 95% CI 1.18 to 2.23; NNTH 17.
• Antihistamine-analgesic-decongestant: 6 trials (1014 participants). Five trials reported on global effectiveness, of which two studies in adults could be pooled: global effect reported with active treatment (52%) and placebo (34%) was equivalent to a difference of less than one point on a four- or five-point scale; the OR of treatment failure was 0.47 (95% CI 0.33 to 0.67); NNTB 5.6 (95% CI 3.8 to 10.2). One trial in children aged 2 to 12 years, and two trials in adults found no beneficial effect.Adverse effects: in one trial 5/224 (2%) suffered adverse effects with the active treatment versus 9/208 (4%) with placebo. Two other trials reported no differences between treatment groups.

References

• De Sutter AI, Eriksson L, van Driel ML. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev 2022;(1):CD004976. [PubMed]