Sometimes referred to as: bronchitis, pharyngitis, sinusitis, tonsillitis, and colds
Upper respiratory tract infections are acute, contagious infections that affect the nose, sinuses, and throat. They are caused by viruses or (less frequently) bacteria that can also affect the bronchi (upper airways) and lungs.
Over 1 billion.
Among adults, 2-4 per year. Among children, 6-8 per year.
Low (except among the immunocompromised).
Sore throat, runny nose, and feeling rundown are the most common initial symptoms. Fever, if present, typically occurs during the first few days. Nasal congestion and cough usually come on the second or third day. Many infections improve after seven to ten days. However, some, such as influenza, can have a longer course.
Here, the clinician’s mind is usually trying to determine three things: First, is this viral or could it be bacterial? Second, if this is bacterial, does this person need antibiotics to kick it? Third, what are the best supportive therapies for this individual, regardless of viral versus bacterial, based on their symptoms and treatment preferences?
After ten days, about 60% of sinus infections can be considered bacterial. If someone presents with ten days of facial pressure and thick nasal discharge, we’ll consider using antibiotics, though most of those infections would self-resolve even if not treated.
Fever greater than 102 F for more than two or three days may suggest a bacterial cause (although some viruses such as the flu can have fevers that last five-to-seven days). Persistent sore throat or the inability to swallow can indicate a more severe throat infection that may need prompt medical intervention.
Bronchitis (a chest cold) is almost always viral, but if it’s associated with shortness of breath, night sweats, or high fevers, we start to get concerned about pneumonia, which should be treated with antibiotics. (Additionally, we keep a closer eye on less resilient individuals, including older people and those with compromised immune systems.)
“Double worsening” refers to a pattern of initial improvement followed by worsening between days five and ten. That’s suggestive of a bacterial cause.
As for ongoing symptoms, nasal discharge and coughs last the longest. It’s not uncommon for these to linger for several weeks with a viral infection.
For head colds, facial tenderness or pain radiating to the teeth can occur with both viral and bacterial infections.
As for other symptoms, duration beyond seven-to-ten days, severity, and “double-worsening” are the most important factors in diagnosis. The doctor’s job is to help consider all factors and timelines together to assess clinical likelihood and make real time decisions.
Most people assume that snot color carries valuable clinical information. But in truth, it isn’t very telling. Thickness of snot can be helpful, but it still isn’t a great indicator of bacterial versus viral infections.
The duration of a cough is not as big of a determinant as most people suspect, and usually reflects drainage of mucus from the head into the chest. In fact, we expect most coughs to last two-to-three weeks in this context.
Jamila Schwartz, MD and Andrew Cunningham, MD are both members of the Galileo Clinical Team. Connect with one of our physicians about Upper Respiratory Tract Infection or any of the many other conditions we treat.Join Today