Respiratory tract infections (RTIs)
The name covers every infection of the organs we breathe with: the nose and sinuses, the throat and voice box, the airways and the lungs.
On this page
Medicines commonly prescribed for Respiratory tract infections (RTIs)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 200 mg azithromycin/5 ml reconstituted suspensionActive substance: azithromycinManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 750 mgActive substance: amoxicillinManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Teva Pharma S.L.U.Prescription required
The name covers every infection of the organs we breathe with: the nose and sinuses, the throat and voice box, the airways and the lungs. The common cold, laryngitis, bronchitis, flu, COVID-19 and pneumonia are all RTIs — what differs is how deep the infection goes and how severe it turns out to be. The great majority clear up on their own, without a single tablet, in one or two weeks. But in some people, and in some episodes, the illness takes another course, and the most useful thing to take away from this page is where the line falls between resting it out at home and needing a doctor today.
What counts as a respiratory tract infection
They are grouped by which floor of the airway is affected, and the grouping is not a formality: it tells you what to expect.
Upper airway — nose, sinuses, throat, tonsils, voice box. This is where the common cold, sinusitis, tonsillitis and laryngitis sit. The illness is usually mild: a blocked or runny nose, a sore throat, a hoarse voice, some coughing and a modest temperature. Unpleasant, but rarely dangerous.
Lower airway — windpipe, bronchi, lungs. This is bronchitis, bronchiolitis in babies, and pneumonia. Here the illness lasts longer, brings a high temperature more often, causes real breathlessness, and leaves a cough behind after everything else has settled. These are the infections that deserve attention.
Flu and COVID-19 do not fit the scheme neatly: they may stay in the nose and throat or move down into the lungs, so they are watched separately.
Almost all RTIs are caused by viruses, and there are hundreds of them. That is why an adult catches something several times a year and a child at nursery rather more often. It is not a sign of a weak immune system but ordinary arithmetic: the body meets the viruses one at a time.
How it usually runs, and for how long
The symptoms are familiar to almost everyone: a blocked or running nose, sneezing, a sore or scratchy throat, headache, aching muscles, tiredness, a temperature, and a cough — dry at first, later bringing up phlegm.
The timings are more useful than the list. Fever and aching usually last three or four days. A sore throat clears in about a week. A blocked nose takes a week and a half. The cough, though, lags behind everything else: it can carry on for two or three weeks after a person already feels well. The lining of the airways repairs slowly, and a cough that drags on is not in itself a complication or a reason for antibiotics.
Phlegm often changes colour along the way, turning yellow or greenish. Contrary to a widespread belief, the colour says nothing about bacteria: it reflects how many broken-down immune cells the mucus contains, and it changes in exactly the same way during an ordinary viral infection.
Signs you cannot wait on
Some situations call not for an appointment but for immediate help: an ambulance or the emergency department. In Spain, Italy, Portugal, Poland and Ukraine the ambulance is called on the single European number 112.
- Breathlessness at rest: breathing is hard work, a sentence cannot be finished in one go, the person has to sit propped up on their arms.
- Chest pain that gets worse on breathing in or coughing.
- Coughing up blood, or phlegm streaked with blood.
- Lips, face or nails turning blue or grey.
- Confusion, unusual drowsiness, difficulty rousing the person — especially an older one. In older people pneumonia often shows itself not through cough and fever but through sudden muddled thinking, a fall, or abrupt weakness.
- A rash that does not fade when a glass is pressed against it.
In children the warning signs are different, and they are not tied to temperature:
- fast, laboured breathing; the spaces between the ribs, the dip at the base of the neck or the tummy under the ribs pull in with each breath;
- grunting with each breath, or the nostrils flaring;
- refusing drinks, passing much less urine than usual, dry nappies in a baby;
- floppy or unresponsive, not behaving as normal — or, the other way round, impossible to settle;
- in a baby in the first months of life, any high temperature at all.
When a doctor is needed the same day
An ambulance is not called for here, but the visit should not be put off:
- the temperature lasts more than three or four days, or climbs again after things had improved — that second rise often means a bacterial infection has been added on top of the virus;
- there is no improvement after a week, or a clear deterioration;
- the cough goes on for more than three weeks;
- breathlessness appears on everyday exertion when it never used to;
- the illness falls during pregnancy;
- there is a long-term heart, lung or kidney condition, diabetes, or a weakened immune system, whether from treatment, chemotherapy or the illness itself;
- the patient is an older person or a baby under one year old.
Long-term lung conditions deserve a line of their own. With asthma or COPD an ordinary cold can set off a flare-up, and the thing to do is follow the plan agreed with the doctor in advance rather than wait until breathing is genuinely bad.
Why antibiotics will not speed recovery
This is the most common expectation of a consultation and the most common disappointment. Antibiotics kill bacteria. They do nothing at all to viruses — not to flu, not to the rhinoviruses behind colds, not to the virus that causes COVID-19. And viruses cause the overwhelming majority of respiratory infections.
The consequence matters. An antibiotic taken for a viral infection will not shorten the illness by a single day, will not bring the temperature down and will not prevent a complication. What it can do is add problems of its own: diarrhoea, nausea, rash, an allergic reaction, thrush in women, and occasionally a severe inflammation of the bowel. There is also a shared cost: the more often antibiotics are taken without need, the more resistant bacteria there are around, and the smaller the chance the drug will work on the day it is genuinely needed.
A doctor will prescribe an antibiotic on seeing signs of a bacterial infection — pneumonia, for instance. Sometimes a chest X-ray or a sample of phlegm is needed to establish that. If an antibiotic is prescribed, the course is finished exactly as written, and half a packet is not saved for next time: leftovers from an earlier course are, after self-prescribing, the second reason these medicines stop working.
What genuinely helps at home
A viral infection cannot be cured faster than it clears by itself, but it can be made a great deal easier to sit through.
- Rest and sleep. Not heroics at work but actual rest: someone who is short of sleep stays ill longer and infects colleagues.
- Fluids. Warm and plentiful — they loosen the phlegm and make it easier to cough up.
- A hot drink with honey and lemon soothes the throat and settles a cough. Honey is not given to babies under one year old; that rule is about botulism and it is a firm one.
- Gargling with warm salt water for a sore throat. Not suitable for small children, who swallow the solution.
- An extra pillow at night: with the head raised, nose breathing is easier and the night-time cough is less troublesome.
- Painkillers and fever medicines from the paracetamol and anti-inflammatory groups ease aching, headache and sore throat. Watch that the same active ingredient does not arrive twice over: combined cold sachets almost always contain paracetamol, and together with a separate tablet the daily limit is easily exceeded.
- Aspirin is not given to children or teenagers — during a viral infection it is linked to a rare but severe injury to the liver and brain.
Decongestant nose sprays make breathing easier but are not used for more than a few days in a row: the lining adapts, and the blockage comes back from the spray itself. Cough syrups and lozenges work mainly by coating the throat and tasting pleasant; they do no harm, but not much should be expected of them either. Children must not be left to breathe steam over a bowl of hot water — scalds during such inhalations are a classic household injury. And do not smoke while you are ill: smoke pushes recovery further away.
How to avoid catching it and passing it on
Respiratory viruses travel in the droplets thrown out by coughing, sneezing and talking, and on hands — from a door handle to your own face.
So while you are ill: cover your mouth and nose with your elbow or a tissue, bin the tissue straight away, wash your hands more often than usual, stay at home for the first days if you can, and keep away from babies, older people and anyone with a weakened immune system. If you have to go out, a mask noticeably lowers the risk to everyone else.
Anyone who falls ill often or severely does well to discuss vaccination with their doctor — the yearly flu jab above all, and, depending on age and health, the pneumococcal vaccine, which protects against the commonest cause of bacterial pneumonia. Who is eligible and from what age is set by each country's immunisation schedule, and these differ: ask your own doctor. Giving up smoking cuts the frequency and severity of these infections more than any other single measure.
Online consultation
A cold is exactly the situation where a trip to the clinic is often unnecessary yet the question remains. An online appointment works well for going through the symptoms and judging whether this is an ordinary infection or something outside the usual pattern; for deciding whether a face-to-face examination and a chest X-ray are warranted; for working out what to do about a cough that will not settle; for making sense of an antibiotic already prescribed and its side effects; for choosing safe remedies in pregnancy or for a child; and for putting together a plan for colds if you have asthma or COPD.
Have ready: the day the illness started and how it has changed since, temperature readings by day, a list of the medicines you take including over-the-counter sachets, and your long-term conditions. If there is a pulse oximeter at home, measure your oxygen saturation and give the figure.
One important caveat: the urgent signs listed above are not assessed online. They need an ambulance, not a consultation.
This material is for information only and does not replace medical advice.
Consult with a doctor about Respiratory tract infections (RTIs)
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Respiratory tract infections (RTIs)
Discuss your symptoms and possible next steps for Respiratory tract infections (RTIs) with a doctor online.
