Antibiotics for Sinus Infection

When to Use and Avoid Antibiotics and Other Treatments to Try

Sinus infections that do not clear up on their own may need treatment with antibiotics. Common antibiotics for bacterial sinus infections include the Z-pak, also known as Zithromax (azithromycin), Augmentin (amoxicillin/clavulanate), and others.

A sinus infection (sinusitis) can be treated with antibiotics when it is caused by bacteria. Sinus infections that have other causes, such as allergies or viruses, will not benefit from antibiotics. Your healthcare provider will let you know if you need an antibiotic.

This article will look at when antibiotics for sinus infections are needed and the types of antibiotics that are commonly prescribed for them. It also discusses over-the-counter (OTC) treatments and home remedies for managing sinus infection symptoms.

woman with sinus infection
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When Antibiotics Are Needed

Antibiotics can help clear up bacterial sinus infections, but will not help if a sinus infection is caused by allergies, a virus, or a problem with the stature of the sinuses. In these cases, other treatments are needed. 

Allergists and other specialists recommend limiting the use of antibiotics for situations when a sinus infection has signs of being caused by bacteria, including:

  • Symptoms lasting more than seven to 10 days
  • Fever
  • General signs of infection like redness, swelling, or pus

Overuse and Resistance

Sinus infections were often treated with antibiotics in the past, but today healthcare providers warn against using the medications when they’re not needed. A long history of prescribing antibiotics when they were not truly needed has led to antibiotic resistance.

Antibiotic resistance means that certain drugs no longer work against a specific type of germ. Sometimes, it means a bacteria changed in response to exposure to antibiotics and now the treatments are not effective.

Antibiotic resistance can also develop in a person's body, and then when the infection is spread to other people in the community, it will also be resistant to treatment. 

Unfortunately, it's hard to know if a sinus infection is bacterial, viral, or has another cause just by looking at symptoms. 

Still, providers do look at symptoms for clues. For example, since viral sinus infections tend to improve in 5 to 7 days, providers will sometimes only prescribe antibiotics if you have symptoms for longer. 

A sinus infection that goes on for longer than a week or keeps getting worse is likely to be bacterial. 

Common Antibiotics for Sinus Infections

Antibiotics may be prescribed when symptoms of a sinus infection warrant such treatment. Common antibiotics for sinus infection include:

  • Augmentin (amoxicillin/clavulanate)
  • Zithromax (azithromycin)
  • Septra (trimethoprim-sulfamethoxazole)
  • Amoxil (amoxicillin)
  • Levaquin (levofloxacin) (note: although this drug is sometimes prescribed as a first line of therapy for sinusitis, it has serious side effects and should only be used as a last resort)

Which Antibiotic Should I Use?

The best antibiotic for a sinus infection will depend on several factors. For example, while penicillin antibiotics (like amoxicillin) can be very effective, people who are allergic to penicillin will need to take a different kind of antibiotic that has also been shown to help clear up sinus infections (like azithromycin). 

Over-the-Counter Treatments

Before prescribing an antibiotic, your provider might want you to try an over-the-counter (OTC) treatment for a sinus infection such as:

  • Nasal decongestants and antihistamines. There are several OTC combination drugs available, but ask your provider or pharmacist before using them for a sinus infection.
  • Nasal decongestant sprays. These sprays can help open the sinuses and relieve symptoms on a short-term basis but should not be used for longer than a few days. Using a steroid nasal spray such as Nasacort or Flonase may help relieve nasal congestion without causing the rebound effect (where the congestion gets worse after you stop using it).
  • Allergy medications. Medications such as Claritin or Zyrtec may help if allergies are the underlying cause of sinusitis.
  • Nasal corticosteroid sprays. Nasal corticosteroid sprays help prevent inflammation and swelling in the sinuses and nasal passages. These sprays can also help reduce swelling from sinus infections. One of the advantages of using this type of nasal spray is that it does not cause a rebound effect and is safer for long-term use than other types of nasal sprays.

Warning About Decongestants

Note that decongestants can help relieve nasal and sinus congestion but they should not be taken if you have certain medical conditions, such as glaucoma or high blood pressure (hypertension).

Ask your healthcare provider before using any type of OTC medication to treat a sinus headache, especially if you take any medication or you have a medical condition.

Home Remedies

Saline nasal rinses can flush out thickened mucus and allergens from the nasal passages and relieve dryness. Studies have shown that using a low-pressure, high-volume saline nasal rinse can provide fast, long-lasting improvement in quality of life for people who have chronic sinus infections.

Be sure to ask your provider before using a saline nasal rinse.

Using the Right Water During Saline Rinses

When using saline nasal rinses, tap water should always be boiled and then allowed to cool to make sure it is clean. Distilled water or premixed solutions could be used instead of regular tap water.

Other home remedies for sinus infections include:

  • Staying hydrated. Drinking lots of fluids helps loosen and thin mucus. Avoid beverages that are caffeinated (like coffee) and alcoholic beverages that can dehydrate the body, which can thicken mucus.
  • Breathing in steam. Warm water is best (not too hot). You can breathe in steam from either a bowl or shower.
  • Humidifying the air. Use a cool air vaporizer or humidifier, particularly at night while sleeping.
  • Avoiding environmental irritants. Avoid tobacco smoke and chlorinated water, which can dry up the mucus membranes and make your symptoms worse.
  • Starting treatments early. At the first sign of infection, use antihistamines and do regular nasal rinses.

When to See a Provider

If you think you have a sinus infection, you may not be able to manage it on your own at home. You should call your provider if you:

  • Have symptoms like a bad headache and face pain
  • Have symptoms that are not getting better or are getting worse
  • Have had a fever for more than three days

Your provider can find out if your symptoms are being caused by an infection and make sure you get the right treatment.

The sooner you start treating a sinus infection, the better. It’s also important that you finish the treatment your provider prescribes for you, even if you start feeling better before it’s done. 


Antibiotics are only needed for sinus infections that are caused by bacteria. If you have a sinus infection from a virus, allergies, or another cause, there are some other treatments you can try. 

If you have symptoms of a sinus infection and you’re not feeling better or start feeling worse after a week or so, call your provider. They can figure out if you need to take antibiotics to clear up the infection and prescribe the one that will be the safest and work the best for you. 

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Sinus infection.

  2. KidsHealth from Nemours. What happens when antibiotics are overused?

  3. Egan M, Hickner J. Saline irrigation spells relief for sinusitis sufferersJ Fam Pract. 2009;58(1):29-32.

  4. Dehler, J. Allina Health. Ten home remedies to relieve sinus pain and pressure.

  5. Centers for Disease Control and Prevention. Sinus infection.

By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.