Upper Respiratory Infections
Common colds, pharyngitis and sinusitis — self-care and when antibiotics are needed
Upper respiratory infections (URIs) are among the most frequent reasons for GP consultations in the UK. They range from the common cold to sore throats, sinusitis, and ear infections. The vast majority are caused by viruses and resolve on their own — understanding when antibiotics are truly needed helps protect everyone.
What are URIs?
Upper respiratory infections are infections affecting the nose, throat, sinuses, and ears. The common cold (viral rhinitis) is the most frequent form, causing a runny or blocked nose, sneezing, sore throat, and mild fever. Pharyngitis and tonsillitis refer to infection and inflammation of the throat and tonsils. Acute sinusitis is inflammation of the sinuses, often following a cold. Acute otitis media is an infection of the middle ear, most common in children. These conditions are overwhelmingly caused by viruses — particularly rhinoviruses, coronaviruses, adenoviruses, and influenza — and most resolve without antibiotic treatment.
Causes & Spread
Viruses are responsible for the vast majority of upper respiratory infections. Bacterial infections, most notably Streptococcus pyogenes (Group A Strep), can cause bacterial tonsillitis and pharyngitis — these account for only around 10-30% of sore throat presentations. Spread occurs via respiratory droplets (coughing, sneezing) and direct contact with infected secretions. Most URIs are more common in winter months when people spend more time indoors in close contact. Risk factors include young children (frequent exposure in schools), immunosuppression, smoking, and crowded living conditions.
Signs & Diagnosis
Most URIs are diagnosed clinically based on symptoms. For sore throats, validated scoring tools help to guide management decisions: the FeverPAIN score (Fever, Purulent tonsils, Attend rapidly within 3 days, severely Inflamed tonsils, No cough or coryza) and the Centor score help identify those most likely to have bacterial tonsillitis. A score suggesting bacterial infection guides whether antibiotics are likely to be of benefit. Clinical evaluation includes examining the throat, ears, and sinuses; checking temperature; and assessing lymph nodes. Rapid antigen testing for Group A Strep is increasingly available. Red flag features include difficulty swallowing, drooling, stridor, uvular deviation (suggesting quinsy — peritonsillar abscess), or signs of epiglottitis.
Self-care & Antibiotic Stewardship
Most URIs resolve with supportive self-care: rest, adequate hydration, paracetamol or ibuprofen for pain and fever, and saline nasal rinses for congestion. Antibiotics are not effective against viral infections and their overuse drives antibiotic resistance — one of the most serious global health threats. NICE guidelines recommend that antibiotics should not be routinely prescribed for colds, most sore throats, or sinusitis lasting fewer than 10 days. A delayed prescribing strategy — where a prescription is given but the patient is advised to wait and collect it only if not improving after a few days — is evidence-based and widely used. Always consult your GP or pharmacist before starting antibiotics, and never share antibiotics with others. Seek help urgently if breathing becomes difficult, you are drooling or cannot swallow, you have a very stiff neck, or symptoms are rapidly worsening.