Upper Respiratory Infection (URI)

Upper vs lower respiratory infections

The upper respiratory tract includes the nose, sinuses, throat and larynx. The lower tract includes the windpipe, bronchi and lungs. Lower respiratory infections, such as acute bronchitis and pneumonia, tend to cause deeper cough, chest discomfort, breathlessness and, in pneumonia, higher fever. A URI can spread downward in some people.

Types of upper respiratory infection

Symptoms

• runny nose, which may become thick and yellow or green (coryza)
• stuffy nose and sneezing
• sore or scratchy throat
• cough, often worse at night from post-nasal drip
• hoarse voice
• mild fever, more common in children
• headache, tiredness and body aches
• reduced sense of smell and taste
• watery eyes

Flu and COVID-19 can start like a URI but usually cause more sudden, severe illness with high fever, chills, muscle aches and exhaustion.

How long does an upper respiratory infection last?

• days 1 to 3: sore throat, sneezing, runny nose, symptoms building
• days 3 to 5: peak congestion and cough
• days 7 to 10: most symptoms resolve
• a lingering cough can last 2 to 3 weeks

Adults typically get 2 to 4 colds a year, and young children 6 to 8 or more.

Is it contagious?

Yes. Viral URIs spread through droplets from coughs and sneezes, close contact, and touching contaminated surfaces and then the eyes, nose or mouth. People are most contagious in the first 2 to 3 days of symptoms and can spread the virus for up to 2 weeks.

Diagnosis

Most URIs are diagnosed from symptoms and a brief exam. Tests are used when they change treatment:

• rapid strep test or throat culture for sore throat with fever, swollen glands and no cough
• flu or COVID-19 tests, especially for people at higher risk of complications who may benefit from antivirals
• chest X-ray only if pneumonia is suspected

Treatment

Self-care

• rest and plenty of fluids
• saline nasal spray or rinses (use distilled, sterile or boiled water for rinses)
• a humidifier or steamy shower
• warm drinks with honey for sore throat and cough (not for babies under 12 months)
• salt-water gargles and throat lozenges for older children and adults
• raise your head at night to reduce post-nasal drip

Over-the-counter medicines

• pain and fever relief: acetaminophen (paracetamol) or ibuprofen. Follow the label dose. Do not give aspirin to children or teenagers
• decongestants: nasal sprays for no more than 3 days. Oral decongestants are not suitable for people with high blood pressure, heart disease or glaucoma
• antihistamines: may dry a runny nose slightly
• cough and cold medicines are not recommended for children under 6 (and are not recommended under 4 by US manufacturers)

Antibiotics

Antibiotics do not treat viral infections and do not shorten a cold. Unnecessary use causes side effects and antibiotic resistance. They are used for:

• strep throat confirmed by testing
• bacterial sinusitis: symptoms over 10 days, severe symptoms with high fever, or worsening after initial improvement
• other confirmed bacterial complications, such as ear infections in some children

Antivirals

For flu and COVID-19, antivirals may be recommended for people at higher risk, ideally started within the first days of symptoms.

Complications

• sinusitis and ear infections
• asthma and COPD flare-ups
• bronchitis and pneumonia
• rarely, peritonsillar abscess after tonsillitis, and rheumatic fever after untreated strep throat

Prevention

• wash hands often with soap and water
• avoid touching your face
• cover coughs and sneezes
• stay home when sick
• get annual flu and up-to-date COVID-19 vaccines, and RSV vaccines if eligible
• do not smoke, as smoking increases URI frequency and severity

Frequently asked questions

What is an upper respiratory infection?

It is an infection of the nose, sinuses, throat or voice box, most often caused by viruses. The common cold, viral sore throat, sinusitis and laryngitis are all types of upper respiratory infection.

How long does an upper respiratory infection last?

Most last 7 to 10 days, with symptoms peaking around days 2 to 4. A cough can last 2 to 3 weeks. See a doctor if symptoms last more than 10 days without improving or get worse after starting to improve.

Do I need antibiotics for an upper respiratory infection?

Usually not. Most are viral and antibiotics will not help. Antibiotics are used only for confirmed bacterial infections, such as strep throat, or for sinusitis that lasts more than 10 days, is severe, or worsens after improving.

Is an upper respiratory infection contagious?

Yes. It spreads through droplets from coughing and sneezing, close contact, and contaminated hands and surfaces. You are most contagious in the first few days, so wash hands often and stay home while you have a fever.

What is the fastest way to get over a URI?

There is no cure, but rest, fluids, saline rinses, honey for cough, and pain relievers ease symptoms while your immune system clears the virus. Avoid smoking and alcohol, and give your body time to recover.