Introduction

When a viral respiratory infection like the common cold or mild flu strikes, it often comes with a range of unpleasant symptoms like coughing, congestion, sore throat, and fever. Therefore, many of us turn to over-the-counter (OTC) medications, hoping to find quick and easy relief. But do they really work as well as we hope? In this article, we’ll examine the effectiveness of common OTC medications, and explain alternative ways to manage symptoms.

What are acute viral respiratory infections?

Acute viral respiratory infections (AVRIs) are one of the most common diseases in the world. These illnesses are caused by viral pathogens that infect the respiratory tract (the nose, throat and lungs). Many different types of viruses cause AVRIs.

These include rhinoviruses, coronaviruses, parainfluenza viruses and other disease-causing agents.¹ Probably the most familiar examples of AVRIs are common colds and mild forms of the flu. Depending on the virus causing the infection, an AVRI can spread rapidly through skin drops released into the air when an infected person coughs, talks or sneezes.²

Common symptoms of AVRIs

It often comes with the following symptoms:³

• Coughing: It is caused by irritation or inflammation due to mucus and germs in the throat and airways
• Nasal congestion and runny nose: It is caused by irritation from the virus in the nose and sinus lining, leading to nasal passages swelling and increased mucus production
• Sore throat: It results from inflammation of the pharynx caused by the virus attacking the cells lining the throat
• Fever and headaches: A part of the body's natural immune response- raising its temperature to help fight off the infection
• Fatigue and body aches: Signals that your body is hard at work battling the virus

Why don’t antibiotics work for these infections?

Unlike bacterial infections that can be treated with antibiotics, AVRIs are caused by viruses with different mechanisms of infection than bacteria. Antibiotics are drugs made to kill bacteria or inhibit bacterial growth and therefore have no effect on viruses.⁴ In fact, antibiotics should not be used for viral infections, as they may not only be ineffective, but can also contribute to antibiotic resistance.

Since the body's immune system is typically able to kill the virus, for most mild cases, treatments focus on managing symptoms rather than treating the infection itself. Therefore, over-the-counter (OTC) drugs are rolled out to help alleviate the symptoms caused by AVRIs.⁵

Can over-the-counter drugs really help?

When you're experiencing AVRI symptoms, reaching for over-the-counter (OTC) drugs often feels like the obvious choice. While these medications can help manage symptoms, it’s important to understand what they do or don’t.

OTC drugs are designed to relieve discomfort from symptoms like coughing, congestion, sore throat, and fever, but they don't directly target the virus causing the infection. In other words, these medications won’t speed up recovery from a cold or flu. It’s your immune system that fights off the virus, which can take anywhere from a few days to a couple of weeks, depending on the severity of the infection.⁵

What OTC medications can do is help you feel more comfortable during the recovery process, potentially allowing you to rest better and go about your daily activities with less discomfort. Rest and hydration are especially important as they play a key role in helping your body recover from a viral infection.⁶

Types of OTC medications for AVRIs

There are plenty of over-the-counter (OTC) medications available to help with the different symptoms of viral respiratory infections. The most common types are following:⁷

• Pain relievers and fever reducers: Medications like acetaminophen and ibuprofen can lower fever and ease the aches and pains that come with AVRIs
• Decongestants: Pseudoephedrine and phenylephrine are often used to clear up nasal congestion, helping you breathe more easily
• Cough suppressants and expectorants: Dextromethorphan works to calm a persistent cough, while guaifenesin thins out mucus, making it easier to get rid of
• Antihistamines: Usually taken for allergies, antihistamines can also help with a runny nose and sneezing by blocking the body’s histamine response
• Throat lozenges and sprays: These offer quick relief for a sore throat by soothing irritation and numbing the area, though the effect doesn’t last long

Prescription antiviral medications

In some cases, doctors may prescribe antiviral drugs that directly target the virus, particularly for severe viral respiratory infections. Medications like oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab)and baloxavir marboxil (Zofluza) are designed to reduce the severity and duration of the infection when taken early on in the illness.

These antivirals are typically not available over the counter and are usually prescribed to older adults with weakened immune systems, children, or individuals at high risk for complications, such as those with asthma, diabetes, or heart disease.⁸

Which OTC medications work best for different symptoms?

Over-the-counter (OTC) drugs alleviate various symptoms of AVRIs, such as pain, congestion, cough, and sore throat. However, not all drugs work equally for all symptoms, and understanding how to treat certain symptoms can help you choose the right treatment. Below you will find a summary of the OTC treatments and evaluate their effectiveness.

Pain relievers and fever reducers

Pain relievers like acetaminophen and ibuprofen are two of the most widely used medications to reduce fever and alleviate pain associated with AVRIs.

Acetaminophen 

This is often recommended to reduce fever and treat mild to moderate pain. It works by blocking pain signals in the brain and helps lower body temperature when you have a fever, making it a great option for quick pain relief.

Ibuprofen

A nonsteroidal anti-inflammatory drug (NSAID), not only reduces fever and pain but also helps with inflammation. Unlike acetaminophen, it acts on the entire body, not just the brain, which makes it a good choice for treating more intense body aches, headaches, and sore throats.

One study found that both acetaminophen and ibuprofen are safe at over-the-counter doses and equally effective for treating cold and flu symptoms. There was no evidence showing any significant difference in their efficacy or their safety.⁹

Decongestants

Nasal congestion is a common symptom of AVRIs, and decongestants like pseudoephedrine and phenylephrine are often used to provide relief.

Pseudoephedrine 

This drug works on narrowed blood vessels in the nasal passages, which reduces swelling and helps you breathe more easily. It’s generally considered more effective at relieving congestion compared to phenylephrine.¹⁰

Phenylephrine 

This is another OTC option for sinus and nasal relief, and it also reduces blood vessel swelling in the nasal passages, but it’s often seen as less effective than pseudoephedrine.

While decongestants can offer temporary relief for a stuffy nose, they can also cause side effects like increased blood pressure, heart palpitations, or insomnia, especially if taken before bed. The NHS also advises limiting caffeine intake when using these medications to avoid worsening these side effects.¹¹

Cough remedies

Coughing is another common AVRI symptom, and the right remedy depends on the type of cough you have. Cough treatments are generally divided into two categories: suppressants and expectorants.

Dextromethorphan 

A cough suppressant that works by reducing your brain’s urge to cough. It’s great for dry, unproductive coughs that can disrupt sleep or daily life. While it’s effective for quieting those annoying coughing fits, it doesn’t help clear mucus from your airways.¹²

However, guaifenesin is an expectorant that reduces mucus, allowing to clear the airways. It’s better suited for productive, wet coughs where you need to expel mucus from the respiratory tract.¹³

In short, suppressants like dextromethorphan are ideal for dry, hacking coughs, while expectorants like guaifenesin are more useful when you need to clear mucus. Choosing the right treatment based on your cough type is important to support your body’s natural healing process.

Throat lozenges and sprays

Sore throats from AVRIs can be really uncomfortable, and throat lozenges and sprays are a go-to for quick relief.

Menthol lozenges and other medicated drops numb the throat and give a cooling sensation. They can make it easier to swallow and calm the irritation, though the relief doesn’t last very long.

Throat sprays, like those with benzocaine, work in a similar way by numbing the area. They provide fast relief, but it wears off quickly, so you may need to use them again after a short while.

While lozenges and sprays can help soothe a sore throat, they don’t treat the underlying cause of the irritation.

Are there other ways to manage symptoms?

While OTC medications can help relieve symptoms of AVRIs, natural remedies often provide effective alternatives without the side effects of medication. Staying hydrated is crucial, as drinking water or herbal teas helps thin mucus, making it easier to expel and easing congestion. Rest and sleep allow the body to focus on recovery, and ease the symptoms like fatigue and body aches.

Using a humidifier adds moisture to the air, can be helpful for soothing irritated airways and relieves nasal congestion and coughing, especially in dry environments. Consuming honey and warm liquids can soothe a sore throat and suppress a cough, while saltwater gargles ease throat irritation.⁶ 

Home treatments are ideal for mild symptoms, providing comfort and relief without the risks associated with excessive medication use.

Conclusion

OTC medications are effective at managing symptoms of AVRIs like pain, fever, congestion, and cough, but they do not cure the infections or shorten their duration. They offer comfort, enabling patients to rest and recover more easily. Choosing the right treatment based on symptoms, such as pain relievers for aches or decongestants for stuffy noses, can help improve comfort during illness.

Complementary natural remedies, like staying hydrated and resting, are also valuable in supporting the body’s recovery process. Professional medical advice should be sought for severe cases or high-risk individuals.

Summary

Acute viral respiratory infections (AVRIs), such as the common cold and mild flu, are common ailments caused by viruses like rhinoviruses, coronaviruses, and parainfluenza viruses. Symptoms include coughing, congestion, sore throat, fever, fatigue, and body aches. Since these infections are viral, antibiotics are ineffective, and treatment typically focuses on symptom management using over-the-counter (OTC) medications.

OTC medications, though unable to shorten the duration of the infection, can help alleviate symptoms and provide comfort. Pain relievers like acetaminophen and ibuprofen reduce fever and aches, while decongestants such as pseudoephedrine and phenylephrine provide temporary relief from nasal congestion. Also, cough remedies, including dextromethorphan (for dry coughs) and guaifenesin (for wet coughs), target specific types of coughs, while throat lozenges and sprays offer short-term relief for sore throats.

Although OTC medications can manage symptoms effectively, natural remedies such as hydration, rest, humidifiers, and warm liquids can also provide symptom relief without the side effects associated with medications. In severe cases, prescription antiviral medications may be required, particularly for high-risk individuals.