Respiratory tract infections affect the nose, throat, sinuses, or lungs. Most are viral and improve with time and symptom relief, but some require testing or prescription treatment.

Carrie Hoarty, MD, an internal medicine physician, explains the common types and how providers diagnose and treat them.

What is a respiratory tract infection?

A respiratory tract infection is an illness that affects part of the respiratory system. Symptoms may include:

• Sore throat
• Runny nose
• Congestion
• Cough
• Fever
• Chills
• Muscle aches

“Most respiratory illnesses start as viral infections, and we like to treat them conservatively with over-the-counter medications,” Dr. Hoarty says. “But if they go on beyond 10 to 14 days, or if you have shortness of breath or chronic health conditions that put you at risk for a more serious complication from the respiratory illness, then it is appropriate to seek care.”

What are the most common types of respiratory tract infections?

Many different viruses can cause the common cold. Influenza, COVID-19, and respiratory syncytial virus (RSV) may cause similar symptoms. Other infections include sinusitis, strep throat, ear infections, and pneumonia.

Symptoms alone do not always show whether an infection is viral or bacterial. 

“Even if mucus is thick and green or yellow, it can still be viral,” Dr. Hoarty says. “That just means there’s inflammation; it doesn’t necessarily give us a clue whether it’s viral or bacterial.”

Because antibiotics do not treat viruses, they should be reserved for bacterial infections.

How are respiratory tract infections diagnosed?

A provider may diagnose an infection by reviewing your symptoms, how long they have lasted, and what they find during an exam. 

For example, facial pain or pressure after 10 to 14 days of upper respiratory symptoms may point to sinusitis. Throat redness, white patches, swollen lymph nodes, and fever – usually without a runny nose or cough – may indicate strep throat.

Testing is most useful when the result could change treatment or help protect a close contact who is older, immunocompromised, or an infant. A swab may test for flu, COVID-19, and RSV, while a clinic test can help diagnose strep throat. 

How are respiratory tract infections treated?

Treatment depends on the cause of the infection. Options may include:

• Rest, fluids, and symptom relief for most viral infections
• Antiviral medicine, such as Tamiflu, for some people with the flu, especially when started early
• Antibiotics for bacterial infections, such as some ear infections, strep throat, sinus infections, or pneumonia

Your provider can help determine the cause of your infection and recommend the right treatment.

What can you do at home to feel better?

Many mild viral infections improve with simple home care. Depending on your symptoms, options may include:

• Acetaminophen or ibuprofen for fever or discomfort
• Saline sinus rinses or a nasal spray for congestion or a runny nose
• An over-the-counter antihistamine, like Claritin, Allegra, or Zyrtec
• Saltwater gargles or tea with honey for a sore throat
• Zinc lozenges started early in a viral illness
• Rest and fluids

“For fevers or discomfort, you can use Tylenol or ibuprofen, but ibuprofen should be used with caution by people who have high blood pressure or a history of stomach ulcers,” says Dr. Hoarty. “Decongestants such as Sudafed or phenylephrine should also be used with caution by people with high blood pressure, and they can make it harder to concentrate or fall asleep.” 

A provider or pharmacist can help you determine which medication is right for your specific symptoms.

When should you see a health care provider?

Consider contacting a health care provider if symptoms continue beyond 10 to 14 days or you are not improving. Seek care sooner if you have:

• Shortness of breath
• Trouble eating or drinking
• Difficulty completing basic daily activities
• A concern that you are not doing well at home.

Earlier evaluation may also be appropriate for people who:

• Are immunocompromised
• Are undergoing chemotherapy
• Take immune-suppressing medicines
• Have COPD, asthma, heart disease, or diabetes
• Have previously needed hospitalization or a ventilator for a respiratory illness

“It’s okay to call your primary care physician and share your symptoms,” Dr. Hoarty says. “A telehealth appointment or visiting an Immediate Care Clinic can also be helpful.”

If you have a complicated medical condition, Dr. Hoarty adds, it may be best to be seen within your health system so the provider can review your medical history in your chart.

How can you help prevent respiratory tract infections?

You cannot prevent every infection, but a few habits can reduce the chance of spreading illness. 

“If you’re feeling ill, stay home if you can, or wear a mask if you need to be out in the community with an upper respiratory infection,” Dr. Hoarty says. “Excellent hand hygiene is also really important.”

Getting a flu shot can lower your risk of serious illness. COVID-19 and pneumonia vaccines may also be recommended, so ask your provider which vaccines are right for you.

FAQ

Are most respiratory tract infections viral or bacterial?

Most start as viral infections. A provider can use your symptoms, the length of illness, an exam and, when needed, testing to decide whether a bacterial infection is likely.

Does green or yellow mucus mean I need an antibiotic?

No. Mucus can become thick or change color because of inflammation during a viral infection. Color alone does not show that an illness is bacterial.

When might I need a flu, COVID-19, or RSV test?

Testing may help when the result could change your treatment or help protect a close contact who is at higher risk.

How long should I wait before contacting a provider?

Many mild viral illnesses improve with home care. Contact a provider if symptoms last longer than 10 to 14 days or concern you. Seek care sooner for shortness of breath or difficulty managing basic needs at home.