Antibiotics for Sinus Infection
People with painful sinus problems often plead with their doctors to give them an antibiotic as soon as possible. About 83% of adults seen in the U.S. by a doctor for acute sinusitisend up getting an antibiotic, research shows. And most don't need it.
Acute sinusitis is a sinus infection that lasts less than 4 weeks, while chronic sinusitis lasts longer than 12 weeks. Infections of the sinuses (hollow air spaces within the bones in the cheekbones, forehead, and between the eyes) are usually caused by viral or bacterial infections. They cause thick mucus blockage and discomfort in the cavities.
But antibiotics may not always be the best remedy for sinusitis. Your body should be able to cure itself of a mild or moderate sinusitis, and you should avoid antibiotics that can cause antibiotic resistance.
Many medical guidelines, including those issued jointly by the American Academy of Allergy, Asthma & Immunology, the American College of Allergy, Asthma, and Immunology, and the Joint Council of Allergy, Asthma & Immunology, now recommend the judicious (cautious) use of antibiotics.
Antibiotics for Sinus Infections
The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60%-70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.
In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.
This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.
Patients who got no treatment were as likely to get better as those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problems and seemed to worsen the condition of those with more intense congestion.
All patients had sinus symptoms that suggested a bacterial infection. However, sinus problems can also be caused by viruses, for which antibiotics definitely offer no help.
Is Your Sinus Infection Caused by a Virus or Bacteria?
Doctors may not know if sinusitis is bacterial or viral because the diagnosis is typically done by observing symptoms. Symptoms include:
- Nasal congestion
- Pain or discomfort around the eyes, forehead, or cheeks
- Cough
- Headache
- Thick nasal or post-nasal drainage
- Fever
Sometimes other tests such as a CT scan or cultures are used to help make the diagnosis.
Some doctors give patients with sinusitis a prescription for antibiotics and recommend them to wait 3-5 days before filling it. They suggest their patients fill it only if their symptoms are not better by then. The longer the symptoms last, the more likely a sinus problem is to be a bacterial infection, some experts say. A decongestant can be used to help relieve your symptoms and promote drainage.
Know that just 2% of sinus infections are caused by bacteria, according to the American Academy of Allergy, Asthma & Immunology. The vast majority of infections are caused by a virus.
When to Take Antibiotics for Sinus Infection
You may get antibiotics if:
- You're less able to fight off infections (for instance, if you have diabetes, or a serious heart or lung disease).
- Your symptoms have gotten worse or shown no improvement after 5 days.
If antibiotics are given, you normally take it for 10 to 14 days.
Signs of a sinus infection getting better with antibiotics
After about a week of being on antibiotics, you should see that:
- Your fever has reduced.
- Your nose is no longer stuffy and filled with mucus.
- Your headache and sinus pain have reduced.
If you've been on antibiotics and nothing changes after 7-10 days, you likely have a viral infection. This is why your doctor might tell you to wait a few days before filling a prescription for antibiotics, to see whether symptoms start to clear up on their own.
Best Antibiotics for Sinusitis
Your doctor might give you one of the following sinus infection antibiotics for your bacterial sinusitis:
Amoxicillin for sinus infection
Amoxicillin (Amoxil) or amoxicillin clavulanate (Augmentin) are typically the first recommendations for people not allergic to penicillin.
Amoxicillin is a penicillin-like antibiotic used to treat all kinds of infections, including chest, ear, and sinus infections. It stops the growth of bacteria. Clavulanate prevents bacteria from destroying amoxicillin, so the combination of the two drugs is preferred by doctors over just amoxicillin.
Doxycycline for sinus infection
This drug belongs to a class of medicines called tetracycline antibiotics. It's used to kill bacteria or prevent its growth. If you're allergic to penicillin, your doctor may prescribe this. Doxycycline (Doryx, Periostat) is also used to treat acne and anthrax.
Azithromycin for sinus infection
Azithromycin (Z-Pak) is usually given as a 5-day treatment course and is very popular. But the Infectious Diseases Society of America now warns against using it to treat sinusitis, as its overuse has led to the development of drug resistance. It stops the growth of bacteria and is also used to treat bronchitis, pneumonia, and sexually transmitted diseases, among other infections. Azithromycin belongs to a class of drugs called macrolides.
Other drugs used to treat sinus infections include:
- Cefixime (Suprax)
- Cefpodoxime (Vantin)
- Clindamycin (Cleocin)
- Fluoroquinolones (Levofloxacin, Cipro)
Antibiotics for Sinus Infection While Pregnant
Not all antibiotics can be given to you while you're pregnant. Some are OK but others aren't
It's not a good idea to take macrolide antibiotics or doxycycline for sinusitis when you're pregnant. Penicillin and cephalosporin antibiotics are safer, especially if there's evidence of pus in your sinuses.
Other antibiotics such as tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones can harm the baby, so they shouldn't be used during pregnancy.
Feeling Worse After Starting Antibiotics for Sinus Infection
If you've been on sinus infection antibiotics for 7 days and your symptoms are the same or worse, let your doctor know. They may have to put you on a different antibiotic since many bacteria are now immune to certain antibiotics.
It's also possible that your sinus infection is not bacterial but viral. Or you might have something more serious, like a blockage in your nasal cavity. In order to see that, your doctor would need to give you a CT scan, which is an imaging test. You may get this if you've tried two different antibiotics that didn't work.
Best Over-the-Counter Medicine for Sinus Infection
Here are some sinus infection medicines you can get at your drugstore that can help with your symptoms:
- For sinus pain and headaches, try acetaminophen (Tylenol) or ibuprofen (Aleve, Motrin).
- For a stuffy nose, try a decongestant (such as Afrin, Dristan, or Sudafed) or nasal spray (Flonase, Nasonex).
- You could also buy a saltwater spray or make your own saline solution to treat your stuffy nose.
Getting plenty of rest and drinking lots of fluids will also help you recover.
Takeaways
Antibiotics shouldn't be your first choice if you have a sinus infection because most of these infections are caused by viruses, and antibiotics only work on bacteria. But if your sinusitis is caused by bacteria, your doctor may prescribe amoxicillin clavulanate or doxycycline (if you're allergic to penicillin) to help you get well. Most of the time, sinus infections will go away on their own without any special medication, though you can take over-the-counter pills to help with the pain.
Antibiotics for Sinus Infection FAQs
How long does it take for a sinus infection to go away without antibiotics?
Most sinus infections (about 70%) go away within 2 weeks without any antibiotics.
What makes sinusitis worse?
Cigarette smoke, dry air, pollutants, hay fever, and changes in air pressure are just some of the things that make sinusitis worse.
