Respiratory Illnesses: When Do You Actually Need Antibiotics?

You're three days into what feels like the worst cold of your life. Your head is pounding, your chest aches with every breath, and you're exhausted. You finally make it to a clinic, hoping for relief, and after a quick exam, you hear those frustrating words: "It's just a virus. Over-the-counter medicines. Rest and fluids."

You leave feeling frustrated, wondering what you can actually do to feel better.

I get it, literally, I get it because our family of four has had what seems like non-stop colds since Halloween. We are already looking forward to summer! Hearing you have a virus can be unsatisfying, especially when you're miserable and looking for help. But here's what I want you to know: when an emergency medicine physician tells you it's viral, there's actually a lot happening behind that diagnosis, and there is much more we can do.

Below, I outline what doctors can do, beyond telling you, “get rest and stay hydrated,” and which symptoms indicate when antibiotics are actually helpful.

Understanding Why "It's Just a Virus" Can Feel Frustrating

Let's start with why this phrase can be hard to hear. You're not feeling "just" anything. You’re dealing with congestion that makes it hard to breathe, a cough that keeps you up at night, body aches, headaches, fever, and exhaustion that makes even simple tasks feel overwhelming. That feels miserable. 

When you’re feeling that sick, hearing “it’s just a virus” can sound like your symptoms are being downplayed, or that nothing meaningful can be done to help. But the reason we’re careful about prescribing antibiotics isn’t that we don’t want to help. It’s because antibiotics only work against bacterial infections, not viruses.  Many patients that I see have an expectation for an antibiotic prescription because that is how they have been treated in the past, a friend or family member got a prescription for similar symptoms, etc.  It can be tempting as a physician to prescribe an antibiotic for these patients, but we have taken an oath to do no harm.  

Using antibiotics when they aren’t needed can cause real harm. Inappropriate antibiotic use contributes to antibiotic resistance, which, according to the CDC, causes more than 2.8 million infections and 35,000 deaths each year in the United States. When we determine your illness is viral, we're actually protecting you from the medications that won’t help—and could cause unnecessary side effects—while focusing on treatments that will make you feel better.

What Emergency Medicine Doctors Actually Do for Viral Illnesses

Here's what a comprehensive evaluation looks like at RightCare Clinic, and why emergency medicine training matters even for "common" illnesses.

Diagnosing a Virus

When you come in with respiratory symptoms, we're listening to your lungs carefully, checking your oxygen levels, assessing how hard you're working to breathe, and evaluating your overall condition. We're looking at your vital signs to understand how your body is responding to the illness.

This comprehensive approach helps us distinguish between someone who needs symptom management and someone who might be developing complications like pneumonia or dehydration.

How to Manage Your Symptoms

"Rest and fluids" is good advice, but there’s so much more we can offer. Depending on your specific symptoms, we can provide targeted strategies that provide real relief.

For severe congestion, we can recommend specific decongestants or nasal sprays that work best for your situation. A couple of my go-to treatments are pseudoephedrine (Sudafed), which is over the counter but kept behind the pharmacy counter. I am a big fan of natural cough suppressants like tea with honey. If you're struggling with chest tightness, breathing treatments can help open your airways. When coughing is disrupting your sleep and recovery, we can suggest appropriate medications based on whether your cough is dry or productive.

For patients who are significantly dehydrated, IV hydration therapy can help them feel dramatically better within an hour.

What To Do If Your Symptoms Don’t Improve

One of the most valuable things we provide is clear guidance on what's normal for viral illness progression and what signals a problem. Most viral respiratory illnesses peak around days 3-5, then gradually improve over 7-10 days. Most sinus infections clear with conservative over-the-counter treatment within 2 weeks.  

We'll explain the specific warning signs that mean you should return for further evaluation: difficulty breathing, chest pain, high fever lasting more than three days, symptoms that improve then suddenly worsen, or confusion and extreme fatigue.

This knowledge helps you feel confident managing symptoms at home while knowing exactly when to seek additional care.

When Do You Need Antibiotics?

Sometimes antibiotics are necessary. Certain symptoms suggest bacterial rather than viral infection: fever above 101°F lasting more than 5 days, severe sinus pain with thick, colored discharge for more than 10 days, difficulty swallowing with visible pus on the tonsils, or symptoms of pneumonia.

At RightCare Clinic, we have the tools to make accurate diagnoses, so you don’t need to see multiple doctors. To help determine if you need antibiotics, you might need chest X-rays to check for pneumonia, rapid tests for flu, COVID-19, and RSV,  lab work to check white blood cell counts, or a test for strep throat.

When testing indicates a bacterial infection, antibiotics should be prescribed thoughtfully, selecting the right medication for the specific infection and explaining exactly how to take it.

The Right Level of Care

When you’re sick, waiting days for a primary care appointment isn’t always an option. Many patients come to RightCare Clinic because they need same-day care, know their symptoms don’t require an emergency room visit, but still want a thorough evaluation.

We can assess whether your illness can be managed with symptom treatment alone or if further testing is needed, with on-site diagnostics available without referrals. You can get clear answers and a treatment plan in one visit, saving time and providing peace of mind.

Getting the Care You Need

When you're sick, you deserve a thorough evaluation, effective symptom management, clear communication about what to expect, and confidence in knowing when to seek additional help. It isn’t “just” a virus.

Not every illness needs antibiotics, but every patient deserves comprehensive care that addresses their symptoms and concerns.

Experiencing respiratory symptoms that aren't improving, or aren't sure if what you're dealing with needs professional evaluation? Schedule a same-day appointment at RightCare Clinic by calling 616-888-3710 or booking online. Our board-certified emergency medicine physicians provide thorough assessments with immediate access to on-site diagnostics, so you get answers and relief in one visit.

Todd Chassee, MD, FACEP, is Medical Director for RightCare Clinic and Vice President of Clinical Services at Emergency Care Specialists

This educational content is for informational purposes only and does not replace professional medical advice. Always consult your physician or a qualified health provider with medical questions. If you could have a medical emergency, call your doctor, 911, or go to the nearest emergency room immediately. RightCare Clinic does not endorse specific tests, physicians, products, procedures, or opinions. This content does not establish a physician-patient relationship.