Managing your child’s upper respiratory infection: When are antibiotics necessary?

Kids get colds, ear infections and sore throats all the time. These are upper respiratory infections, a term for infections of the nose, throat and ears caused by viruses or bacteria.

As a parent, it’s natural to wonder: Will my child just get better on their own, or do they need antibiotics?

Understanding when antibiotics are helpful for these kinds of infections can guide you in making the best choices for your child’s health.

When do antibiotics help with an upper respiratory infection?

In children, most of these infections are caused by viruses. Antibiotics do not work on viral infections and won’t speed recovery or make your child feel better if the illness is viral.

Antibiotics are effective only against bacterial infections, such as:

• Strep throat
• Ear infections (which often start as viral before becoming bacterial)
• Bacterial sinus infections

 Antibiotics are not effective for viral infections like:

• Common colds
• Flu
• Croup
• Viral sinus infections

Sinus infections can be caused by viruses, allergies or bacteria. However, because there’s no test to pinpoint the cause of a sinus infection, doctors often wait a couple of weeks to see if symptoms improve before prescribing antibiotics.

Doctors prescribe antibiotics carefully to prevent inappropriate use that can lead to antibiotic resistance — when bacteria evolve and become harder to treat.

How can I tell if my child has a viral or bacterial infection?

It can be hard to tell if an upper respiratory infection is viral or bacterial because these symptoms often overlap:

• Congestion and/or runny nose (including green or yellow mucus)
• Cough
• Sneezing
• Fever
• Sore throat
• Fatigue

Seasonal allergies can also cause congestion, coughing and sneezing.

The best thing to do is contact your child’s primary care provider or visit urgent care. The doctor will ask about symptoms, listen to your child’s breathing with a stethoscope and examine their ears with an otoscope before recommending treatment.

Depending on symptoms, the doctor may suggest home care, prescribe antibiotics or perform rapid tests for viruses like RSV, flu, strep or COVID.

Helping your child through a viral infection

If a virus is causing the infection, you can ease symptoms by:

• Using a humidifier, such as a cool mist vaporizer
• Encouraging rest
• Offering plenty of fluids
• Using saline nasal drops
• Giving over-the-counter acetaminophen or ibuprofen as needed

Never give aspirin to children, and avoid ibuprofen in babies younger than 6 months. Children less than two months old should not take acetaminophen, unless instructed by your doctor.

To reduce spreading the infection, wash your hands often, wipe down shared surfaces, cough or sneeze into a tissue or your sleeve, and keep other family members away from the sick child when possible.

Tips for taking antibiotics for a bacterial infection

If your child has a bacterial infection, the doctor will prescribe an appropriate antibiotic.

Common side effects include diarrhea and upset stomach. Stop the antibiotic and call your doctor if your child develops a rash — it may be harmless but could be an allergic reaction.

Consider adding probiotics like active-culture yogurt or kefir to your child’s diet. Antibiotics kill both harmful and helpful bacteria, so probiotics help restore healthy digestion and immune support.

How long until antibiotics start working?

It usually takes at least 24 hours to notice improvement. Ear and sinus infections may take two to three days. Make sure your child finishes the entire prescription to fully clear the infection.

Seek emergency care immediately if your child has trouble breathing or shows changes in mental status, such as sleepiness or lethargy. Also, contact your doctor if these symptoms last two or more days:

• Fever above 101°F
• Worsening symptoms, change in mental status or difficulty breathing