Upper Respiratory Tract Infections: When Can Antibiotics Help?

During a cold and flu season, it’s natural to think, I’m feeling awful — I must need antibiotics.

But from a medical standpoint, antibiotics aren’t widely recommended. They often don’t work at all for common infections, and can even cause harm in the long run.

What Causes Upper Respiratory Tract Infections?

Coughs and colds are commonly referred to as upper respiratory tract infections, and can be caused by two types of germs: bacteria and viruses.


Viral upper respiratory infections and bacterial rhinosinusitis infections often have similar symptoms, such as coughing, head and chest congestion, and mucus or phlegm that can be clear or yellow-green. Especially when phlegm goes from clear to green, you might think antibiotics are required to cure the infection.

But Antibiotics Fight Bacterial Infections

Antibiotics are medicines that stop an infection caused by bacteria, which are germs that cause illnesses such as strep throat, pneumonia and some sinus and ear infections.

However, antibiotics do not work against infections caused by viruses. And most coughs, colds and sore throats are caused by a virus.

For example, treatment of a sinus infection with antibiotics during the first week of symptoms is not recommended, because the infection typically is not bacterial at that point.


A diagnosis of bacterial sinus infection may be made in children and adults with symptoms of a viral upper respiratory infection that have not improved after 10 days, or that worsen after five to seven days. Patients may have some or all of the following symptoms:

  • nasal drainage
  • nasal congestion
  • facial pressure or pain
  • postnasal drainage
  • fever
  • cough
  • feeling tired
  • tooth ache or pain
  • ear pressure or sensation of fullness

How Do Antibiotics Work?

Even in bacterial infections where antibiotics should be taken, it’s possible to use them incorectly.

Antibiotics kill off the weaker germs the first few times you take them. At first you start to feel better. However, the stronger germs are still alive. If you stop taking the antibiotics too soon (as soon as you start to feel better) the stronger germs can keep growing. If you do this, soon the antibiotics won’t work anymore, a phenomenon known as antibiotic resistance.


When this occurs, germs that can’t be killed by antibiotics can sometimes take over when all of the weaker germs are killed. It can happen when you take the same antibiotic too many times, or when germs are left over in your body after you have been taking these medications incompletely. When this happens you may need a stronger antibiotic. Some kinds of resistant bacteria are so strong that no antibiotic will work.

Neither you nor your doctor wants to get familiar with antibiotic resistance.

Preventing Antibiotic Resistance

Remember the 3 cardinal rules:

  1. You should use antibiotics only when your doctor prescribes them.
  2. They should not be shared with anyone else.
  3. Don’t stop taking the medication too soon, and take it exactly as your doctor tells you to.

Patients who have symptoms of “common cold” as discussed earlier should start with adequate fluid intake, rest, humidified air and over-the-counter analgesics such as Tylenol for fever and body aches.


Some medications such as decongestants, antihistamines or cough suppressants may not be appropriate for some patients, so consult your physician before taking them. If symptoms do not improve in 10 days or worsen after 5 to 7 days consult your physician. Even if antibiotics are prescribed and you do not respond after 72 hours, further reevaluation may be needed.


There is a time and place for antibiotics. Use them properly, and they will continue to work well when you really need them the most.


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