Most upper respiratory infections are caused by viruses, which means antibiotics won’t help. Treatment focuses on managing your symptoms while your body fights off the infection, and most people recover within 7 to 10 days. The good news is that a combination of over-the-counter medications, simple home remedies, and rest can make you significantly more comfortable during that time.
A URI can affect your nose, sinuses, throat, and voice box. The common cold is the most frequent type, but the flu, COVID-19, and RSV all fall under the same umbrella. Regardless of which virus is responsible, the treatment approach is largely the same: relieve symptoms and let your immune system do its work.
Pain, Fever, and Headache Relief
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are the two main options for the body aches, headaches, sore throat pain, and fever that come with a URI. You can use either one, or alternate between them on different doses.
For acetaminophen, a standard adult dose is two 325 mg tablets every six hours or two 500 mg tablets every eight hours. Do not exceed 3,000 mg in a 24-hour period. For ibuprofen, three 200 mg tablets every six to eight hours is typical, with a maximum of 2,400 mg per day. Stick to these limits for the first five to seven days of your infection, and don’t take more than one product containing the same active ingredient at a time. Many cold medicines already contain acetaminophen, so check the labels carefully to avoid doubling up.
Treating Congestion and Sinus Pressure
Nasal congestion is often the most disruptive URI symptom, and you have several tools to address it.
Saline nasal rinses are one of the safest and most effective starting points. A sinus rinse (like NeilMed or a neti pot) physically flushes mucus and irritants from your nasal passages. The CDC recommends using only distilled, sterile, or previously boiled water for sinus rinsing. If you boil tap water, bring it to a rolling boil for one minute (three minutes at elevations above 6,500 feet), then let it cool completely before use. Never rinse your sinuses with untreated tap water.
Nasal steroid sprays like fluticasone (Flonase) or triamcinolone (Nasacort) can reduce inflammation and swelling. Use two sprays per nostril once daily, ideally after a saline rinse so the medication reaches the tissue more effectively.
Decongestant nasal sprays containing oxymetazoline (Afrin, Sinex) work fast for severe stuffiness, but limit use to three days and never more than five. Longer use causes rebound congestion, where your nose becomes more blocked than it was before you started. Oral pseudoephedrine (Sudafed), available behind the pharmacy counter, is another option for sinus congestion. Follow package directions and stay under 240 mg per day.
Soothing a Cough and Sore Throat
A persistent cough is one of the last URI symptoms to resolve and can linger for two weeks or more even after you’re otherwise feeling better. Honey is a surprisingly effective cough suppressant. For children age 1 and older, half a teaspoon to one teaspoon of honey can calm a cough. Adults can take a full tablespoon straight or stirred into warm water or tea. Never give honey to a child under 12 months old due to the risk of infant botulism.
Warm liquids in general help soothe an irritated throat and thin mucus. Warm broth, herbal tea with honey, and even just warm water with lemon all provide temporary relief. Gargling with warm salt water (about half a teaspoon of salt in a cup of warm water) can reduce throat pain and swelling.
Using a Humidifier Safely
Adding moisture to dry indoor air can ease a stuffy nose and irritated airways. Cool-mist humidifiers are particularly helpful for children with colds. Heated humidifiers, interestingly, don’t seem to offer the same benefit.
A humidifier that isn’t properly maintained can make things worse by spreading bacteria and mold into the air. Use distilled or demineralized water instead of tap water, which contains minerals that encourage bacterial growth. Empty the water tank, dry the inside surfaces, and refill with clean water every day. Every three days, clean the tank with a 3% hydrogen peroxide solution and rinse thoroughly. Replace the filter as often as the manufacturer recommends, or more frequently if it looks dirty.
Why Antibiotics Usually Don’t Help
Viruses cause the vast majority of URIs, and antibiotics only work against bacteria. According to CDC guidelines, 90 to 98% of sinus infections are viral, and routine antibiotic treatment for bronchitis is not recommended regardless of how long the cough lasts. At least 200 different viruses can cause the common cold alone.
The one common exception is strep throat, caused by group A streptococcal bacteria. But strep accounts for only 5 to 10% of adult sore throat cases, and it requires a positive rapid test before antibiotics are appropriate. Taking antibiotics when you don’t need them contributes to antibiotic resistance and can cause unnecessary side effects like diarrhea and yeast infections.
Treating Children Safely
Over-the-counter cough and cold medicines carry important age restrictions for kids. The FDA recommends against giving these products to children under 2, citing the risk of serious and potentially life-threatening side effects. Manufacturers voluntarily label their products with a warning not to use them in children under 4. Homeopathic cough and cold products for young children have no proven benefits either, and the FDA advises against them for children under 4.
For young children, safer alternatives include honey (for those over age 1), saline nasal drops, a cool-mist humidifier, and plenty of fluids. If you do give an older child an OTC product, use only the child-formulated version and measure doses carefully. Never give children medicines packaged or formulated for adults.
Signs Your URI Needs Medical Attention
Most URIs resolve on their own, but certain symptoms suggest a bacterial complication or a more serious infection. Contact a healthcare provider if you experience a fever above 103°F, a fever that returns after seeming to improve, symptoms that worsen after initially getting better (a pattern that can signal a secondary bacterial infection), difficulty breathing or shortness of breath, symptoms lasting longer than 10 days without improvement, or severe facial pain that doesn’t respond to over-the-counter treatment. In children, watch for high fever, refusal to drink fluids, unusual drowsiness, or labored breathing.