At the first signs of a cold, is over-the-counter medicine enough? When should I see a doctor?
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A scratchy throat, a runny nose, a slight fever. When people in Japan think "this might be a cold", most wait it out with a "combination cold medicine" (総合感冒薬, sōgō kanbōyaku) from the drugstore (Matsumoto Kiyoshi, Welcia, etc.). That is often perfectly fine. But some behaviour is clearly best avoided, such as going to a clinic to ask for antibiotics, or stacking several medicines on top of each other.
What OTC medicine can and cannot do
| Item | Content |
|---|---|
| Cause of colds | Around 90% viruses (rhinovirus, coronavirus, RS virus and others — over 200 types). Bacterial causes are a minority |
| Antibiotics (antibacterial drugs) | Do not work on viruses. The Ministry of Health, Labour and Welfare's *Manual of Antimicrobial Stewardship* recommends not prescribing antibiotics for an ordinary cold. Unnecessary use increases resistant bacteria |
| Combination cold medicine (OTC) | A mix of several ingredients: fever and pain relief, runny-nose relief, cough suppressant and so on. Eases symptoms, but there is no evidence it shortens the illness |
| Overlapping ingredients | Taking a combination cold medicine plus a fever reducer plus a painkiller easily doubles up acetaminophen or ibuprofen. For OTC acetaminophen, the guide is up to 900 mg a day (follow the product label) |
| Course | Most peak within 3–7 days and ease by about 10 days. A cough alone can linger 2–3 weeks |
| When to see a doctor | 38.5°C or above for 3 days or more, breathlessness or chest pain, unable to take fluids, worsening after more than a week, severe headache or stiff neck, older people, infants, pregnant women, chronic illness (diabetes, heart, lung or kidney) |
- What you can do at home: sleep and rest, fluids (hot water, soup, oral rehydration solution; room-temperature to warm drinks if your throat hurts), indoor humidity of 40–60%, honey for a sore throat (age 1 and over) and gargling.
- Choosing OTC medicine: pick a single-ingredient product that works only on the symptom that troubles you (throat → pain relief, runny nose → antihistamine, cough → cough suppressant). This avoids surplus ingredients and drowsiness. Describe your symptoms to the pharmacist (薬剤師) or the registered seller (登録販売者, tōroku hanbaisha — a licensed OTC adviser found in every Japanese drugstore) and ask.
- Using fever reducers: fever itself is the body's defence response. The guide is to use one when the fever passes 38.5°C and you feel bad, or cannot sleep. Do not give aspirin-type medicines to children (risk of Reye's syndrome).
- If influenza or COVID-19 is suspected (sudden high fever, strong fatigue, joint pain, an epidemic period, sick people around you), antiviral medication is an option within 48 hours of onset, so there is a point in seeing a doctor early.
- Do not pass it on: mask, hand-washing, cough etiquette. Staying away from work or school while you have a fever or cough is now the standard in Japan.
[Verify] Check the wording of the latest edition of the *Manual of Antimicrobial Stewardship* (3rd edition, 2023) and the upper dose limit for OTC acetaminophen before publication.
Misunderstanding 1｜Take antibiotics early and it clears up faster
Almost all colds are caused by viruses, and antibiotics do not work on them. Unnecessary use only adds the risks of side effects and resistant bacteria. A doctor who does not prescribe them is making the right call.
Misunderstanding 2｜OTC cold medicine ends a cold sooner
OTC medicine only eases the symptoms; the length of the cold basically does not change. It is a tool for "feeling more comfortable so you can rest".
Misunderstanding 3｜A fever should be brought down straight away
A fever is a sign that your immune system is working, and there is no need to force it down. Use a fever reducer when you feel bad or cannot sleep, and keep to the dose.
Misunderstanding 4｜Cold medicine plus a fever reducer works better
The same ingredients overlap, raising the risk of strain on the liver and stomach side effects. Check with a pharmacist before combining them.
Misunderstanding 5｜If it has not gone after a week, I just have a weak constitution
Worsening after more than a week, or a high fever that persists, may mean bacterial sinusitis, pneumonia or a different illness. Check whether you meet the criteria for seeing a doctor.
---
Sources
- Ministry of Health, Labour and Welfare, *Manual of Antimicrobial Stewardship, 3rd edition* [抗微生物薬適正使用の手引き 第三版] (2023)
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000120172.html
- Japanese Respiratory Society, *Respiratory diseases: common cold syndrome* [呼吸器の病気：かぜ症候群]
https://www.jrs.or.jp/citizen/disease/
- Ministry of Health, Labour and Welfare, *Using medical services wisely* [上手な医療のかかり方.jp]
https://kakarikata.mhlw.go.jp/
⚠️ Editorial note: the source URLs above were identified by search. Our working environment cannot reach go.jp domains, so the contents have not been checked against the text. Verify every source before publication and record who checked it and when.
About this article
What we share here are ideas and everyday practices passed down among people living in Japan, together with general information drawn from public sources. They are not official recommendations, and they are not professional instruction. Practices vary between households and regions.
This is general information. Results vary from person to person and depend on your own conditions and surroundings.
Please decide for yourself, using your own judgement, whether any of this suits your situation. We cannot accept responsibility for any damage, loss or injury arising from following this article.
This article is not meant to diagnose or manage any specific medical condition. If you are worried about your health, see a doctor rather than relying on your own judgement.
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