Sinus infections can be painful and frustrating, but not all require antibiotics. While bacterial sinusitis may need prescription treatment, most cases improve on their own. Keep reading to learn when antibiotics are needed, which options are commonly prescribed, and tips for relieving symptoms.

What Is Sinusitis?

The sinuses are air-filled cavities in the bones of the face. They produce mucus to moisten the nasal passages and lighten the weight of the skull. Acute sinusitis is the inflammation and infection of the sinuses. If the condition lasts longer than 12 weeks, it is called chronic sinusitis.

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What Are Symptoms of Acute Sinusitis?

Sinus symptoms in people with acute sinusitis typically include nasal discharge (thick, yellow/green mucus), postnasal drip, nasal congestion, facial pressure, and pain and swelling around the nose, cheeks, and eyes.

Other symptoms can include headache, fever, tiredness, cough, bad breath, ear pressure, changes in smell, and aching teeth.

How Do You Treat Viral vs Bacterial Sinus Infections?

Sinus infections are usually caused by viruses. But if the sinuses remain blocked for a long time, it can lead to a bacterial infection. Bacteria that commonly cause sinus infections include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

The treatment is different for viral and bacterial sinusitis. That’s why it’s important to have a sinus infection properly diagnosed and treated by a healthcare provider. If you have a viral sinus infection, antibiotics will not help. However, if your acute sinus infection is caused by bacteria, your doctor may prescribe antibiotics.

When Are Antibiotics Needed For A Sinus Infection?

As noted above, most sinus infections are caused by viruses, similar to the common cold and other upper respiratory tract infections. However, bacterial sinus infections can develop occasionally, either on their own or following viral sinus infections.

Antibiotics cannot kill viruses, and using these drugs to treat viral infections can lead to antibiotic resistance, where antibiotics don’t work as well. However, healthcare providers may prescribe antibiotics to treat acute bacterial sinusitis.

Neither you nor your healthcare provider can tell if your sinus infection is bacterial or viral based on symptoms or physical examination alone. However, some clues may point toward a bacterial infection that may require antibiotic therapy:

Symptom Duration

Viral sinusitis usually improves in 5-7 days.
Bacterial sinusitis is longer lasting, typically 7-10 days.
Symptoms of an acute sinus infection caused by bacteria may improve initially and then worsen again after 7 days.

Symptom Severity

Bacterial infections of the sinuses are more likely to cause severe symptoms, such as high fever, facial pain and pressure, nasal congestion with yellow or green mucus, headache, and bad breath.

However, these are not reliable signs of acute bacterial sinusitis (these symptoms can also be present in people with viral infections).

Talk To Your Healthcare Provider

It’s important to have your sinus infection properly diagnosed and treated by a healthcare professional.

If you have recurrent acute sinusitis, your doctor may take a nasal swab to collect mucus. The sample can then be cultured (grown) in the laboratory to find out what type of bacteria are causing your sinus infections. This will help your doctor prescribe the appropriate antibiotic therapy.

In rare cases, especially in people with weakened immune systems, sinus infections may be caused by fungi instead of bacteria or viruses. Fungal sinusitis can be serious and requires a different treatment approach, making it essential to get an accurate diagnosis from a healthcare provider.

Best Antibiotics For Sinus Infections In Adults

The most common antibiotics prescribed to treat acute bacterial rhinosinusitis are:

Amoxicillin-clavulanate (Augmentin) (most commonly prescribed)
Amoxicillin

Other antimicrobial agents that can be used to treat bacterial sinusitis include:

Cephalosporin antibiotics such as cefpodoxime or cefixime
Clindamycin
Levofloxacin
Moxifloxacin

Alternatives for patients allergic to penicillin include:

Fluoroquinolones (levofloxacin, moxifloxacin)
Cephalosporins (see above)
Tetracyclines (doxycycline)

Note: The following treatments apply to uncomplicated acute bacterial sinus infections in adults without risk factors for resistant bacteria. Your doctor may recommend a different treatment if you have underlying conditions, a weakened immune system, recent antibiotic use, or frequent sinus infections.

Duration of Treatment

Doctors usually prescribe a 5-7 day course of antibiotics for adults with uncomplicated acute bacterial rhinosinusitis. However, the duration of antibiotic treatment can be extended if symptoms are severe or persistent.

Amoxicillin and clavulanate potassium (Augmentin), one of the most commonly prescribed antibiotics for acute bacterial rhinosinusitis, is typically dosed for adults at 500 mg/125 mg every 8 hours or 875 mg/125 mg every 12 hours for 5 to 7 days.

Common Side Effects

The most common side effects of Augmentin are upset stomach, nausea, vomiting, diarrhea, and vaginal itching or discharge.

Best Antibiotics For Sinus Infections in Children

Amoxicillin-clavulanate (Augmention) at a dose of 45 to 90 mg/kg/day by mouth is the drug of choice for uncomplicated acute bacterial sinusitis in children.

For patients who are allergic to penicillin, antibiotic choices may include:

Cephalosporins (cefpodoxime, cefdinir)
Levofloxacin (should be used with caution in children due to a higher risk of adverse effects)

Doctors prescribe antibiotics to children based on the child’s body weight. Local antibiotic resistance patterns and the severity of symptoms are also used to determine the best antibiotic for sinus infections in children.

What Is The Best Antibiotic For A Sinus Infection?

Augmentin (amoxicillin-clavulanate) and third-generation cephalosporins are some of the most effective and commonly prescribed antibiotics for sinus infections in adults and children.

Healthcare providers choose antibiotics based on the patient’s medical history, the severity of symptoms, and antibiotic resistance patterns in the community.

However, there is no single best antibiotic for pediatric or adult acute rhinosinusitis that is the most effective for everyone.

Your doctor will prescribe appropriate antibiotic treatment based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines that were prepared by a multidisciplinary panel of experts.

They will take into account your age, medication allergies, symptom severity, and antibiotic resistance risk to choose the best antibiotic for a sinus infection.

Note: Do not use leftover antibiotics or someone else’s antibiotics to self-treat a sinus infection. Only your healthcare provider can tell for sure if you have a bacterial infection and need antibiotic therapy.

Non-Antibiotic Treatments For Sinus Infections

Only take antibiotics if you have been diagnosed with a bacterial sinus infection by a healthcare professional.

Some non-antibiotic medications that can provide relief from sinusitis symptoms include:

Intranasal steroids such as fluticasone (Flonase), budesonide (Rhinocort), beclomethasone (Beconase), and mometasone can reduce inflammation in the mucous membranes of the nose and sinuses.
Nasal decongestants such as pseudoephedrine (Sudafed) and oxymetazoline (Afrin) can reduce mucosal edema (swelling in the nose).
Allergy medications such as cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra).
OTC pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).

Talk to your doctor before taking any over-the-counter medications.

Some examples of home remedies for symptom relief include:

Saline nasal spray or salt water rinses using a neti pot with distilled water can help to clear nasal congestion.
Staying well hydrated can help to thin mucus and make it easier to clear from the nasal cavity.
Steam inhalation can provide relief from a stuffy nose and blocked sinuses.

When To See A Doctor

Call your doctor if you have:

Acute sinusitis symptoms that last more than a week.
Symptoms that get worse after initially getting better.
Recurrent acute sinusitis (repeated bouts of sinus infections).
Chronic rhinosinusitis (symptoms lasting more than 12 weeks) - some people with blocked sinus or nasal passages, for example, due to a deviated septum, may benefit from nasal or sinus surgery.

Seek medical attention immediately if you develop:

High fever.
Neck stiffness.
Pain or swelling around the eyes.
Double vision, blurry vision, or other vision changes.
Confusion.