Page Summary
- The common cold is a viral infection and often causes clear, watery nasal drainage, congestion, sneezing or a sore throat.
- During a viral cold, nasal mucus can become thicker, white, yellow or green. This alone does not mean the infection is bacterial.
- Symptoms are often worst around days 2–3 and then gradually improve.
- Bacterial sinusitis becomes more likely when sinus symptoms persist for 10 days without improvement, or improve and then clearly worsen again.
- I was given an antibiotic prescription to keep. When should I fill it?
Most colds are caused by viruses and get better without antibiotics.
Early in the illness, it is common to have:
- Clear or watery nasal discharge
- A blocked or stuffy nose
- Sneezing
- Sore throat
- Cough
- Headache or facial pressure
- Tiredness or body aches
- Sometimes fever
Symptoms are often worst around days 2–3 and then gradually begin to improve. Some symptoms can take 10–14 days to completely settle.
What can I do for my symptoms?
Treatment is mainly aimed at keeping you comfortable while the viral infection runs its course.
Saline nasal spray or irrigation
Saline can help clear mucus and relieve nasal symptoms. If you use nasal irrigation, use distilled, sterile, or previously boiled and cooled water.
Decongestant nasal spray
Xylometazoline or oxymetazoline can provide rapid relief when your nose is very blocked. These sprays should only be used for a few days. Using them continuously for too long can cause rebound congestion.
Pain and fever medication
Paracetamol (acetaminophen) can help with fever, headache and discomfort. Ibuprofen or another anti-inflammatory medication may also help if it is normally safe for you.
Steroid nasal sprays
A steroid nasal spray can help reduce inflammation and nasal symptoms during a viral illness, and may be particularly useful if you also have underlying nasal inflammation or allergies.
Antihistamines
Antihistamines are generally not needed for a viral cold unless allergies are also contributing to your symptoms.
What if my mucus becomes yellow or green?
Yellow or green nasal discharge does not automatically mean that you have a bacterial infection.
Mucus commonly changes color during a viral illness because of inflammation and the immune cells present in the mucus.
The pattern and duration of your symptoms are much more useful than mucus color alone when deciding whether antibiotics may be appropriate.
When do we start thinking about acute bacterial sinusitis?
Two patterns are particularly important.
1. Sinus symptoms lasting 10 days without improvement
A bacterial sinus infection becomes more likely when you have symptoms of acute sinusitis — particularly cloudy or colored nasal drainage together with nasal blockage and/or facial pain or pressure — that have continued for 10 days or longer without beginning to improve.
The important words are “without improvement.” If you are still having some symptoms on day 10 but are clearly getting better, this is different.
2. Relapse: symptoms improve and then worsen again
Sometimes a cold begins to improve and then relapses, with the symptoms clearly returning. Nasal blockage or discharge may increase, or facial pain or pressure may worsen, after you had started feeling better.
This pattern raises the likelihood of a bacterial sinus infection. It can happen before day 10, so you do not need to wait until day 10 if you clearly improve and then become significantly worse again.
Does bacterial sinusitis always need antibiotics immediately?
Not necessarily. If sinus symptoms continue for 10 days without improvement, or improve and then relapse and worsen again, a bacterial infection becomes more likely, and starting an antibiotic is then discussed.
In uncomplicated cases, where follow-up is available, watchful waiting for a short period while continuing symptomatic treatment is also an option. If there is no improvement within 3 to 5 days after the diagnosis, or the symptoms worsen, starting an antibiotic becomes more appropriate.
Waiting may not be appropriate in some situations, such as a weakened immune system or signs of a complication.
The decision depends on your symptoms, how your illness is progressing, your general health, and your own preference.
I want to avoid antibiotics as much as possible — how long can I wait?
If the illness is uncomplicated and follow-up is available, it is sometimes possible to wait for a short period while continuing symptomatic treatment. But if symptoms continue without improvement or get worse, prolonging the wait is not advised. The American Academy of Otolaryngology–Head and Neck Surgery guidance indicates that waiting more than 15–20 days from the onset of symptoms before trying an antibiotic is not in the patient's interest if symptoms have not improved or are getting worse.
I was given an antibiotic prescription to keep. When should I fill it?
Sometimes you may be given an antibiotic prescription to keep and use only if your illness develops the features of a bacterial sinus infection. Follow the specific instructions given to you.
You may be asked to start the antibiotic if:
- You develop typical acute sinusitis symptoms that continue for 10 days or longer without improvement, or
- You initially improve and then clearly become worse again.
Do not start the antibiotic simply because your nasal discharge becomes yellow or green. If you are uncertain whether your symptoms have reached the point where you should start it, contact your doctor.
When should I seek medical attention sooner?
The timelines above apply to an otherwise uncomplicated illness.
Seek earlier medical assessment if you become significantly unwell or develop:
- Swelling or redness around an eye
- Changes in vision or double vision
- Difficulty or pain moving the eye
- Significant facial swelling
- A severe or unusual headache
- Confusion, neck stiffness or neurological symptoms
- Rapidly worsening or unusually severe illness
These are not typical features of an uncomplicated common cold.
Important: This page describes a typical, uncomplicated cold in general terms. It is not a diagnosis and does not replace assessment by your own doctor. The timelines and treatments above may not apply in situations such as pregnancy, a weakened immune system, a chronic chest or sinus condition, diabetes, or in young children. Medicines mentioned here, including decongestant sprays and anti-inflammatory medication, are not suitable for everyone — ask your doctor or pharmacist if you are unsure, and do not start or stop a prescribed medication on your own.