Upper Respiratory Infection Info

This page includes general information on managing upper respiratory infections, also known as URIs or the "common cold.” These include sinusitis, pharyngitis, bronchitis, conjunctivitis, and other manifestations. Dozens of different viruses are the typical culprits for URIs, but we manage them the same regardless of which one. Influenza and COVID-19 viruses can cause more severe illnesses, so testing may be warranted if we suspect those.

Most viral URI symptoms will peak within 5-10 days, but some may linger for a few weeks, particularly coughing. While there is no cure or quick fix, the treatments we detailed below can help you feel better and recover faster. We include many of these products, including Rx meds for members, in our Viral Relief Kits!

RE: BACTERIA & ANTIBIOTICS: Most URIs are not caused by bacteria. Thus, antibiotics, which only kill bacteria, are not helpful or warranted in most cases. The FAQ section below provides more information on this, including fevers, testing, signs of bacterial infections, and appropriate antibiotic use.

    • Drink lots of fluids! Aim for at least 5-6 large (8 oz) glasses of fluids daily. Hot beverages can soothe the throat and airways better than cold drinks. 

    • Extra sleep. Getting an additional 1-2 hours of sleep daily at night and/or short naps can help boost your immune system better than any vitamin or pill!

    • NSAID medications. Ibuprofen or Naproxen. Use needed for aches, pains, or fever.

    • Acetaminophen (Tylenol). Use as needed for fevers.

    • Zinc lozenges. Sucking on a zinc lozenge/candy or drink may help slow down the virus and reduce duration of illness, especially if started in first 1-2 days.

    • Time. Our immune system will do its job well in most cases, but it may take at least 3-10 days to feel back to normal-ish.

    • Nasal decongestant sprays.

      • Afrin or generic oxymetazolone. Use before sinus rinse if doing. WARNING: Only use 1-2 times per day for a max of 4-5 days as it can cause "rebound" congestion when used for longer or more frequently.

      • Sprays with capsaicin (yes the spicy stuff!). Xlear Max or similar can can be used several times per day.

    • Nasal/sinus rinse.(OTc, ex: Neti-Pot or similar) Use 1-2 times per day. It helps clear mucous, which is often the cause of a nagging cough.

    • Nasal emollient/oils. (OTC, ex: Ponaris) 2-3 times per day. Best used after sinus rinse if doing. 

    • Decongestant pills.(Behind pharmacy counter) Pseudoephedrine (behind pharmacy counter), 12-hour tablet. (Phenylephrine products are available OTC but not nearly as effective as real pseudoephedrine) Take it once in the morning. WARNING: Avoid if you have a history of high blood pressure or heart disease.

    BACTERIAL SINUSITIS?

    The following suggests a sinusitis (sinus infection) may be bacterial:

    • Not improving or worsening after 10-14 days

    • Fevers (100.4+) after day 5

    • Swelling of the face or eyes

    • Foul smelling or pus-like nasal drainage especially if from one side. (This is not the same thing as yellow/green or thick snot.)

  • Usually, the best treatment for coughing is what helps "post-nasal drip"... see all the above stuff. There are no great or safe medicines to fully suppress a cough, but a few things can help clear airways or tone down a cough, including:

    • Inhaled steam. Breathe in warm steam deeply for 4-5 minutes a few times per day. Using a steam inhaler device like this is convenient, but sitting over a bowl of very hot fluids or hot showers also work. (A room humidifier will not serve the same purpose.)

    • Deep breathing exercises. Getting more air into your bronchioles and lungs helps open airways and loosens mucous. Deep breathing exercises like these are great, or better yet: blowing up balloons! This is best done after inhaled steam.

    • Honey. Believe it or not, a teaspoon of plain ol' honey can help! Do this every few hours as needed. 

    • Lozenges. Various ingredients and flavors.

    • Dextromethorphan. (OTC) This is the active ingredient in many "Robutussin" products or anything labeled with "DM." 

    • Tessalon capsules. (Rx only) It helps reduce "tickle in the throat" and is non-sedating. 

    • Promethazine. (Phenergan, Rx only) Sedating but helpful at bedtime. 

    BACTERIAL LUNG INFECTION? PNEUMONIA?

    Coughing itself is not an indicator of bacterial infection regardless of duration or sputum color. However, the following signs may suggest classic (strep) bacterial pneumonia:

    • Fevers (100.4+) after day 5

    • Sharp or localized chest/lung pain

    • Coughing up blood

    • Shortness of breath (rapid or difficult)

    • Low oxygen levels (below 94%)

    • Saltwater gargles.

    • Lidocaine lozenges (ex: Cepacol)

    • Honey. In hot beverages or alone.

    BACTERIAL (STREP) INFECTION?

    The odds of strep throat are MORE like if:

    • Do NOT have a cough

    • Have a fever over 101+

    • White or yellow patches on tonsils

    • Large lymph nodes at front of neck

    If you have 2-3 of these features, doing a throat swab for strep is a good idea, but even if all 4, there is a 50/50 chance it is strep infection.

    If you have 0-1 of these features, it is very unlikely (less than 2-3% chance) strep bacteria are the culprit. In that case, testing isn’t warranted.

  • Ear pressure, pain, and reduced hearing are typically the result of pressure or fluid building in the ear “drum.” The eustachian tube naturally drains this space, which becomes plugged up by nasal swelling or mucous. So, the best treatment for this is to reduce nasal/sinus symptoms-see above. Other products that may help:

  • URI viruses are the most common cause of "pink eye", aka. conjunctivitis. If a person is having other viral URI symptoms (runny nose, coughing, etc.) + pink or reddened eye(s), a virus is the likely culprit. In that case, the best treatments are:

    • Frequent cool compress

    • Saline drops or lubricating eye drops (refrigerated ones help even more)

    BACTERIAL INFECTION?

    There are a few things that suggest pink eye is a bacterial infection rather than viral, including…

  • Many cold and flu remedies found at stores are no more helpful than placebo based on scientific studies. A few of the common ones are:

    • Mucinex (guaifenesin)

    • Herbal remedies, including Еϲhiոaϲеа.

    • Vitamin C products.

    • Anti-histamines. Benadryl (diphenydramine) or other “PM” products may help sleep but also dries out nasal passages, increasing risk of sinus and ear problems.

    • Homeopathic remedies. (Although some zinc products, which may help, are labeled as such)

URI FAQs & Antibiotics

  • In most cases, this is not helpful and won’t change management. Also, there are dozens of families of respiratory viruses, so testing them all would be very expensive!

  • In addition to coughing, influenza & COVID tends to cause abrupt high fevers (102+) and more severe head/body aches in the first 1-2 days of the illness. During influenza season (November - March in most years), we more strongly suspect the flue with these symptoms. COVID is not seasonal so may be suspected anytime of year.

    Rapid testing for influenza and/or COVID is warranted in all “high risk” people including…

    • Over age 65

    • Children under age 2-5

    • Pregnant women

    • Persons with:

      • Lung disease (asthma, COPD, etc.)

      • Heart disease (CHF, coronary disease, etc.)

      • Diabetes

      • Severe obesity

      • Weakened immune system

      • Active cancer

    • Other severe chronic illnessses

  • The odds of strep throat are MORE like if:

    • Do NOT have a cough

    • Have a fever over 101+

    • White or yellow patches on tonsils

    • Large lymph nodes at front of neck

    If you have 2-3 of these features, doing a throat swab for strep is a good idea.

    If you have 0-1 of these features, it is very unlikely (less than 2-3% chance) strep bacteria are the culprit.

  • Most cases of mycoplasma bacterial infections appear very similar to viral URIs or bronchitis. So, it can be challenging to distinguish them even with an examination. We do have a blood-based lab test for Mycoplasma IgM antibodies that are found by day 7 of an illness in most cases.

    Regardless, most cases of Mycoplasma infection or “walking pneumonia” will get better on their own within 7-10 days without antibiotics.

  • People should presume they are contagious with URI symptoms for at least the first 4-5 days, with or without testing for particular viruses. By day 7, the amount of virus being spread is significantly less. However, we don’t have an easy or effective way to give an exact day/time for “not contagious”. So, for 3-10 days, we recommend people with a viral URI try to minimize contact with people outside their household, especially if having fevers in past 24-48 hours. If a sick person must go to work or school, we suggest taking standard precautions to reduce spreading, including:

    • Washing hands frequently (soap & water, or sanitizers)

    • Masking with 2-3-ply paper “surgical” mask, especially if coughing present

  • Fever is the body’s natural and healthy immune response. We define any temperature higher than 100.4 F as “fever” regardless of a person’s average body temperature—typically 97.0 - 98.9 F.

    A higher fever may suggest a more serious infection, such as influenza or bacteria, but many common URI viruses can cause high fevers in the first 2-3 days of an illness.

    A fever, even a high one of 103-105 F, is not harmful to the body or brain. It will not cause any damage. So, a fever itself is not an “emergency”, nor needs to be corrected except for during febrile seizures. However, lowering a fever with medications can provide some relief of symptoms. We suggest Acetaminophen and/or Ibuprofen for that, but not aiming for a certain number due to “safety.”

    • Fever (100.4) beyond 3-5 days. Most respiratory viral infections will only cause fevers in the first few days; if longer than that, certain viruses (influenza) or bacteria are more suspicious.

    • Facial or sinus pain that is worsening or not improving, after 7-10 days. 

    • Persistent ear pain.

    • White patches on throat.

    • Shortness of breath. 

    • Chest pain. 

    If any of these occur, contact your provider immediately or visit nearest emergency room.

  • This can be difficult to determine, but we use your history, exam findings, and testing to help distinguish viral from bacterial infections. Antibiotics are helpful and warranted in some cases, such as more severe sinusitis, ear infections, strep throat, or bacterial pneumonia.

  • Despite many decades of people, including doctors, saying otherwise, the color of snot, mucous, or phlegm (yellow, green, or purple!) is not a good indicator of bacteria or that antibiotics will be helpful. A good review of that topic is here. 

    If you have foul smelling or pus-like nasal drainage, especially from one side, this can be a sign of bacterial sinusitis.

  • Believe it or not, the providers who seem “stingy” or cautious with antibiotics care the most. It is much easier and faster to quickly hand out antibiotic prescriptions. While seemingly low-risk, antibiotics can and do lead to…

    • Side effects (nausea, diarrhea, yeast infections, more)

    • Allergic reactions, even when a person hasn’t reacted previously.

    • Kills the healthy gut bacteria which can takes months to replenish. This “microbiome” is likely related to many other health problems.

    • Antibiotic resistance. The more we, as a population, use antibiotics the faster bacteria develop resistance to them. We already have “superbugs” that are resistant to nearly every antibiotic we have. Liberal use of antibiotics for URIs will only worsen this problem.