Antibiotics for Upper Respiratory Infections

When and Why You Might Need an Antibiotic for a Cold

Mature woman with cold touching forehead


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Any given adult will get a cold at least a couple of times a year—usually in the fall and winter. Kids can get many colds, maybe even half a dozen or more a year. When you get a cold, also known as an upper respiratory tract infection, should you visit your doctor and get antibiotics?

The truth is, antibiotics for respiratory infections aren’t going to make you feel better sooner, and they might even leave you with side effects that make you feel worse. 

Colds are known medically as upper respiratory tract infections because they’re usually limited to the upper half of your respiratory system—the nose, sinuses, upper throat, larynx, and pharynx. These infections don’t, for example, include infections that affect your lungs, like pneumonia. 

Upper respiratory tract infections are usually caused by viruses, like rhinovirus, coronavirus, or influenza, though rarely (about 2% of the time) they are caused by bacteria. Bacteria that infect the upper respiratory tract are most often S. pyogenes (a group A streptococcus), or sometimes H influenzae.

Due to the development and routine administration of the H. influenzae vaccine over the past 30 years, the incidence of this infection has dropped substantially.

Generally, antibiotics shouldn’t be prescribed for upper respiratory tract infections, even when your doctor suspects bacteria are the cause, because these infections tend to clear up on their own. Antibiotics have not been found to shorten the duration of illness or symptoms of the common cold. 

Antibiotics may be prescribed in a few different situations: 

  • Your symptoms don’t clear up on their own within about 10 days.
  • The doctor suspects a bacterial infection and it has spread to other parts of the upper respiratory system, including the pharynx, larynx, or epiglottis, especially when breathing is impacted or in young children.
  • A doctor will prescribe antibiotics if your infection has spread to your lungs, causing pneumonia. 

Upper Respiratory Infection Symptoms

Common cold symptoms include:

  • Runny, stuffy nose 
  • Sneezing
  • Itchy, watery eyes
  • Sore throat 
  • Cough
  • Muscle pain or weakness 
  • Fatigue 
  • Headache

Fever is a rare symptom of the common cold in adults but may be more likely in children. 

Symptoms of an upper respiratory infection can last up to two weeks but usually peak at around three days and are gone within seven. Upper respiratory infections should clear up on their own without needing interventions from your doctor.

 But complications of colds can occur, including:

  • Sinusitis: An infection in your sinuses causing pain and congestion
  • Otitis media: An ear infection causing pain
  • Pharyngitis: A sore throat, which might be strep throat
  • Epiglottitis: An infection and resulting swelling of the epiglottis, a flap of tissue that covers your windpipe, which can interfere with breathing
  • Laryngotracheitis: Infection of the larynx (which holds the vocal cords), trachea, or bronchi

Some of these complications may require treatment with antibiotics. 

Antibiotics Are Not Always Needed

Most of the time, antibiotics are not indicated for use in treating the common cold or flu. A Cochrane report analyzing the available research into the use of antibiotics to treat colds, published in 2013, found that antibiotics do not work for the common cold, and side effects of antibiotics used for the common cold are common. 

White, yellow, or even green (pus-colored) snot during your cold doesn’t necessarily mean it’s a bacterial infection, so it isn’t a reason to ask for antibiotics.

Overuse and overprescription of antibiotics when they aren’t effective leads to the development of antibiotic-resistant infections. Not only is this a big problem for the entire world, but antibiotics can have nasty side effects for the person taking them.

If you go to the doctor with a cold, they’ll generally treat your symptoms, including suggesting you:

  • Hydrate with water or electrolyte sports drinks
  • Rest and let your body heal
  • Suck on lozenges, hard candies, or ice pops to soothe a sore throat
  • Try antihistamines or decongestants (like pseudoephedrine) for symptom relief
  • Use saline nose drops or sprays or a neti pot–style sinus rinse to help clear congestion 
  • Take pain relievers and fever reducers, including Tylenol (acetaminophen) and Advil (ibuprofen), to address those symptoms

When Antibiotics Are Appropriate

There are only a few situations in which your doctor might prescribe antibiotics when you’re dealing with a cold or flu. Usually, these are secondary bacterial infections caused by the cold or flu symptoms that cause issues in the sinuses or other structures of the upper respiratory system. 

Antibiotics may be helpful if common cold symptoms last for more than 10 days, the Cochrane report found.

Sinusitis

A sinus infection, or sinusitis, is the inflammation of the mucous membranes of the sinuses due to a viral or bacterial infection. The sinuses are hollow cavities in the bones of your face around your forehead and cheekbones.

Sinusitis is often caused by bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and sometimes Staphylococcus aureus and Streptococcus pyogenes

Symptoms of sinusitis include pain, pressure, and tenderness of the areas of the face over the sinuses. You’ll also likely feel stuffed up and have colored snot full of pus. You may generally feel unwell and potentially have a low-grade fever. 

Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain, decongestants to remove congestion in the sinuses, and moist heat to relieve pressure can usually help clear up the infection.

But your doctor may prescribe an antibiotic if you’ve had a sinus infection for more than 10 days. Antibiotics prescribed for sinusitis include Augmentin (amoxicillin-clavulanate) and cephalosporin.

Bronchitis

Acute bronchitis is a lower respiratory tract infection. The infection irritates the bronchial tubes and causes swelling and excessive mucus that causes a cough that can last for a few weeks. This infection is usually caused by viruses, not bacteria, but can lead to secondary bacterial infections. 

Usually, treatment with antibacterials doesn’t shorten the course of bronchitis, so they’re not usually advised to be prescribed. There are a few cases in which antibiotics might be useful:

  • The patient is elderly or has a weakened immune system.
  • The cough hasn’t resolved on its own after several weeks.
  • The patient is prone to pneumonia.
  • Bronchitis is caused by pertussis.

Other Upper Respiratory Tract Infections

There are a few other reasons you might be prescribed antibiotics for an upper respiratory infection. Strep throat, medically known as streptococcal pharyngitis, is a sore throat caused by infection by streptococcal bacteria. It is usually treated with penicillin.

Swelling of the epiglottis, the flap of tissue covering the windpipe, is potentially life-threatening, particularly in children ages 2 to 5 years. Called epiglottitis, this condition can impact breathing and is often caused by infection with the bacteria Haemophilus influenzae type b and should be treated with antibiotics, including a cephalosporin.

If the cold leads to an ear infection, antibiotics may help resolve it if pain relievers and decongestants don’t do the trick. Antibiotic use guidelines for children with ear infections differ based on their age and symptoms.

Managing Side Effects of Antibiotics

While there are some cases in which you may be prescribed antibiotics for a common cold, these medications aren't harmless. There are many side effects of antibiotics. Some are common, and others can be severe and potentially deadly.

  • Allergic reactions (skin reactions including hives, but also, more dangerously, anaphylaxis) 
  • Diarrhea
  • Rashes
  • Vaginal itching or yeast infections
  • Nausea and vomiting

In a dataset from 2013 and 2014, adverse drug reactions caused 4 out of every 1,000 emergency room visits each year. The most common reason for the visit among children was an adverse reaction to antibiotics.

If you or your child is experiencing side effects from a prescribed antibiotic, make sure to tell your doctor to be certain it’s nothing to worry about. They’ll also let you know if you should continue taking it or stop. 

If you’re taking antibiotics, here are a few things you can do to help ward off some side effects of antibiotics:

  • Take a probiotic and eat fermented foods like yogurt and kefir.
  • Limit sun exposure.
  • Take your antibiotic as prescribed (especially with food or fluids if indicated).
  • Make sure to store it correctly (especially if it needs to be refrigerated).
  • Ensure your doctor knows about all other drugs and supplements you’re taking.

A Word From Verywell

When you’re feeling sick, it’s tempting to ask your doctor for anything that might help you feel better. But in many cases, when it comes to the common cold and flu, unnecessary antibiotics may make you feel worse.

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