OTC cough medicines in SA:

The constellation of symptoms defining the common cold, from rhinorrhoea and nasal congestion to coughing and malaise, has been recognised since antiquity. As the most frequent human illness, it is primarily caused by viruses, with the numerous serotypes of rhinoviruses being the most common offenders.

There is no cure for the common cold; recovery hinges on the immune system clearing the virus over time. Indeed, it is the body’s own immune response, rather than the virus itself, that is responsible for most symptoms. Consequently, antiviral therapy is unavailable, and the inappropriate use of antibiotics is not only ineffective but also contributes significantly to the growing burden of antibiotic resistance.

OTC treatments

The mainstay of management, therefore, is symptomatic relief, a role filled by a plethora of over-the-counter (OTC) medicines in South Africa. It is important to note that while these medicines may make a patient feel better, many have no proven efficacy and carry a potential for adverse effects, a concern that is particularly acute in young children.

International guidelines recommend that OTC cough and cold medications should not be used in children under six years of age. The prudent approach is to treat symptoms only if they cause significant discomfort or disrupt sleep or feeding. For adults, the recommended strategy is to avoid polypharmacy and instead select a single-ingredient product targeted at the most troublesome symptom.

Common treatment options

Among the available options, first-generation antihistamines like chlorpheniramine are sometimes used for symptoms of rhinorrhoea and sneezing. Their limited benefit is attributed to anticholinergic effects rather than antihistamine activity, and evidence suggests they are of little value when used alone. They feature more commonly in combination night-time formulas for their sedative side effects.

A crucial safety note is that promethazine-containing medicines are contraindicated in children under two years of age. For nasal congestion, topical decongestants like xylometazoline offer relief but must be limited to three days of use to avoid rebound congestion. In South Africa, oral decongestants such as pseudoephedrine are no longer available as single-ingredient OTC products and are now only formulated in combination with antihistamines or analgesics.

Cough relief

Regarding the core symptom of cough, two common classes of medicine are available. Dextromethorphan is an antitussive that acts on the brain’s cough centre. The other common ingredient is guaifenesin, an expectorant theorised to thin mucus. Many products also include additional components such as caffeine to counteract drowsiness, though often in doses too low to be effective.

Popular herbal remedies like Echinacea have mixed and largely unsupportive evidence, while high-dose vitamin C may slightly reduce the duration of a cold but offers no greater relief than standard OTC remedies.

Conclusion

The South African OTC market offers numerous cough and cold medicines, but their utility is often limited. A cautious and minimalist approach is strongly favoured, emphasising that these products do not cure the cold but may offer limited symptomatic relief for adults. For children, extreme caution is advised, with hydration and rest being the cornerstone of management.

REFERENCES

Summerlin, J, 2025. The Use and Safety of Cough and Cold Medications in the Pediatric Population. J Pediatr Pharmacol Ther. 2025 Feb;30(1):17-26.

Van Schoor, J, 2018. Colds, flu and coughing: a review of over-the-counter cold and flu medicines. South African Academy of Family Practice/Primary Care: 60(3):21-24.