Upper Respiratory Infections

Upper respiratory infections (URI) include colds, sore throats, laryngitis, bronchitis and sinus infections. They are most often caused by viruses. Antibiotics do nothing for viral infections. Most people will get better on their own over about 1 to 3 weeks (yes, WEEKS) when they have a URI. Sometimes, taking medicines like acetaminophen (Tylenol, Tempra), decongestants, antihistamines, and/or a cough syrup make you feel better, but they do not speed your recovery from a URI.

Bronchitis: Bronchitis is an illness characterized by a cough sometimes associated with fever and wheezing. In spite of the fact that almost all bronchitis is caused by a virus, most people visiting the doctor for bronchitis expect to be treated with an antibiotic. This just doesn't make sense, and does no one any good. Most people with bronchitis will get better on their own, though it may take a few weeks. If there is wheezing, an inhaler often helps. Antibiotics may be necessary in people with bad lung disease (especially smoker's lung/COPD who require many inhalers and oxygen), and in those with a cough lasting more than 2 weeks. Patients who are quite ill, with high fever and shortness of breath should certainly be evaluated for possible pneumonia.

Sinusitis: Most sinus infections are caused by viruses, so antibiotics are not useful. Even those with colorful (yellow-green or bloody) sinus drainage don't appear to get better any faster with an antibiotic. If you have been sick for more than a week and symptoms are getting worse, or you have a fever and feel quite ill, then I feel an antibiotic is warranted. For those who have typical sinusitis symptoms for less than a week or so, antibiotics don't seem to make any difference in the outcome. For this reason, I suggest treating sinusitis like any other cold: fluids, Tylenol or Advil, antihistamine/decongestants, salt water nasal spray, and time.

Colds: A cold is caused by a virus. Symptoms include a scratchy throat, nasal congestion, and a mild cough. There may be a low-grade fever, with minor muscle aches and headache. Symptoms usually resolve in 7-14 days. If you develop a high fever (over about 101 F), severe cough, or severe sore throat, you probably ought to see a doctor. Those with relatively minor cold symptoms would probably be better served by staying home, drinking lots of juice, and taking Tylenol and decongestants as needed.

Medicines for URI

Analgesics and antipyretics help relieve pain and reduce fever. Aspirin and Tylenol (acetaminophen) are the best known, though recently ibuprofen (Advil, Motrin, Nuprin) has become popular. Robitussin DM has been used for years, but recent information suggests an antihistamine/decongestant (like Dimetapp) may be better. For a runny nose and cough, a simple antihistamine, like Zyrtec (cetirizine), Claritin (loratadine), or chlorpheniramine can help. Some people with a dry cough benefit from an albuterol inhaler. Afrin is a good nasal spray for congestion, but should not be used for more than a 5 days, as your nose will become accustomed to it, and congestion will increase when you stop using it.

For children less than 6, it is recommended to AVOID all over-the-counter cold medicines. For kids older than a year, honey may be a good cough suppressant.

Overall, I think that rest, fluids, an antihistamine/decongestant and a little Tylenol or ibuprofen are probably all that is needed for most upper respiratory infections. When possible, it is best to avoid antibiotics due to potential side effects, like nausea, diarrhea (or worse, C. difficile colitis), yeast infections and allergic reactions. Colds are an annoyance, and we all want to feel better NOW - but there is still no cure for the common cold. If you have any questions about medicines or you illness, please ask me.