Antibiotics for Upper Respiratory Infections

Most upper respiratory infections (URIs), also known as the common cold, are caused by viruses, which don't respond to antibiotics like amoxicillin. Occasionally, however, you may need to take antibiotics for a lingering upper respiratory infection or a bacterial infection that has spread to other parts of the respiratory system.

While there is generally no need to see a healthcare provider for a URI, you should call your provider if you develop a fever, increased mucus in your cough, a rash, or you seem to be getting sicker. Call 911 if you experience trouble breathing.

This article explores the use of antibiotics for treating upper respiratory infections, and when these medications should and should not be used to treat the common cold.

Mature woman with cold touching forehead


Steve Prezant/Getty

Do Antibiotics Treat Upper Respiratory Infections?

Antibiotics do not treat most upper respiratory infections. This is because URIs are usually caused by viruses, like rhinovirus, coronavirus, or influenza. Antibiotics are not effective against viruses, so they won't help you feel better if your cold is caused by a virus.

Rarely (about 2% of the time) an upper respiratory infection is caused by bacteria. Bacteria that infect the upper respiratory tract are most often S. pyogenes (a group A streptococcus) or sometimes H influenzae.

Antibiotics may help bacterial infections, but in most cases, it is better to let a cold simply run its course. Your healthcare provider may decide antibiotics are needed if:

  • Symptoms don’t clear up on their own within about 10 days.
  • The healthcare provider 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.
  • The infection has spread to the lungs, causing pneumonia.

What Are 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. Most upper respiratory infections should clear up on their own without interventions from your healthcare provider.

Why Antibiotics Are Not Needed

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.

When Are Antibiotics Prescribed for a Cold?

There are only a few situations in which your healthcare provider might prescribe antibiotics when you’re dealing with a cold or flu. Usually, these are secondary bacterial infections 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.

Your healthcare provider 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, excessive mucus, and 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 antibiotics doesn’t shorten the course of bronchitis, so they’re not usually 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 whooping cough (pertussis), a bacterial infection that causes severe coughing fits.

Strep Throat

Pharyngitis is a sore throat. Sore throats are common in colds, but a severe sore throat could be caused by a bacterial infection.

Strep throat, medically known as streptococcal pharyngitis, is a sore throat caused by infection by streptococcal bacteria. It is usually treated with penicillin.

Ear Infection

Otitis media is the medical term for an ear infection that causes pain. Sometimes, a cold can lead to the development of otitis media.

Antibiotics may help resolve otitis media 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.

Other Infections

There are a few other reasons you might be prescribed antibiotics for an upper respiratory infection.

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; it should be treated with antibiotics, including cephalosporin.

Tracheitis is an infection of the trachea. Tracheitis may occur as a complication of a viral URI and is most common in very young children. This infection is usually caused by Staphylococcus aureus bacteria.

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.

 Overuse of 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.

Home Remedies for a Cold

Most colds will resolve at home with rest, over-the-counter medications, and home remedies such as:

  • Hydrating with water or electrolyte sports drinks
  • Sucking on lozenges, hard candies, or ice pops to soothe a sore throat
  • Antihistamines or decongestants (like pseudoephedrine) for symptom relief
  • Saline nose drops or sprays or a neti pot–style sinus rinse to help clear congestion 
  • Pain relievers and fever reducers, including Tylenol (acetaminophen) and Advil (ibuprofen)

Managing Antibiotic Side Effects

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, tell your healthcare provider 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).
  • Store it correctly (especially if it needs to be refrigerated).
  • Ensure your healthcare provider knows about all other drugs and supplements you’re taking.

Summary

Antibiotics won't usually help you recover from the common cold. Most colds are caused by viruses, which can't be treated with antibiotics. Even minor bacterial infections don't usually need antibiotics.

When antibiotics are needed, it's usually because you've developed a complication such as bronchitis or an ear infection. Certain bacterial infections like strep throat may also require antibiotics.

For mild upper respiratory infections, rest and self-care are usually enough. Over-the-counter medications like decongestants and pain relievers can help limit your symptoms while you recover.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jennifer Welsh
Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider.