Most sinus infections are viral and clear up on their own within 7 to 10 days, so the best medicine for the majority of cases is over-the-counter symptom relief rather than antibiotics. Pain relievers, decongestants, saline rinses, and nasal steroid sprays can make you significantly more comfortable while your body fights off the infection. Antibiotics only help when the infection is bacterial, which is less common than most people assume.
Most Sinus Infections Don’t Need Antibiotics
The single most important thing to understand is that roughly 90% of sinus infections start as viral illnesses. Antibiotics do nothing against viruses, and taking them unnecessarily contributes to antibiotic resistance. A bacterial sinus infection is typically suspected only when symptoms persist without any improvement for at least 10 days, or when you experience “double worsening,” meaning you start to feel better and then get noticeably worse again within 10 days.
Other signs that point toward a bacterial cause include discolored nasal discharge (especially on one side), severe facial pain concentrated on one side, and fever above 100.4°F. If your symptoms don’t fit those patterns, you’re almost certainly dealing with a viral infection that will resolve with time and symptom management.
Over-the-Counter Pain Relievers
The throbbing pressure in your forehead, cheeks, or around your eyes is caused by inflammation and fluid buildup in the sinus cavities. Ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) both work well for this. Ibuprofen has the added benefit of reducing inflammation, which can help with swelling in the nasal passages. You can alternate the two if one alone isn’t enough, since they work through different mechanisms and are safe to use together for most adults.
Decongestants for Stuffiness
Decongestants shrink swollen blood vessels in the nasal lining, which opens up your airways and helps trapped mucus drain. They come in two forms: oral tablets and nasal sprays.
Oral decongestants like pseudoephedrine (Sudafed) provide longer-lasting relief but can raise blood pressure and make it hard to sleep. Nasal spray decongestants like oxymetazoline (Afrin) work faster and more directly, but you should not use them for more than 3 to 7 days. Beyond that, they cause rebound congestion, where your nose becomes more blocked than before you started using the spray. If you need decongestant relief for longer than a week, stick with the oral form.
Nasal Steroid Sprays
Over-the-counter nasal corticosteroid sprays like fluticasone (Flonase) and triamcinolone (Nasacort) reduce inflammation inside the nasal passages. Unlike decongestant sprays, they’re safe for extended use and don’t cause rebound congestion. The tradeoff is that they take longer to reach full effect, typically 3 to 14 days, so they won’t give you instant relief. Starting one early in your sinus infection helps most with the mid-to-late phase of symptoms, and they’re especially useful if allergies are contributing to your congestion.
Saline Nasal Rinses
Flushing your sinuses with salt water is one of the simplest and most effective tools for a sinus infection. A neti pot or squeeze bottle physically washes out mucus, allergens, and inflammatory debris, reducing pressure and helping your sinuses drain. Many people find this provides more relief than any single medication.
The one safety rule that matters: never use plain tap water. Tap water can contain amoebas that, while harmless if swallowed, can cause a nearly always fatal brain infection if they enter the nasal passages. Use water labeled “distilled” or “sterile,” or boil tap water at a rolling boil for one minute (three minutes above 6,500 feet elevation) and let it cool completely before use. Store any unused boiled water in a clean, sealed container.
Staying Hydrated and Using Steam
Drinking plenty of fluids helps thin your mucus, making it easier to drain. Water, tea, and broth all count. Breathing in steam from a hot shower or a bowl of hot water can temporarily loosen congestion and soothe irritated nasal tissue. Neither of these replaces medication, but they meaningfully complement everything else you’re doing.
When Antibiotics Are Appropriate
If your symptoms have lasted 10 or more days without improving, or you’ve experienced that double-worsening pattern, your doctor may prescribe an antibiotic. The Infectious Diseases Society of America recommends amoxicillin-clavulanate (Augmentin) as the first-line choice rather than plain amoxicillin, because the added clavulanate covers a broader range of bacteria that commonly cause sinus infections. The standard adult dose is 875 mg/125 mg taken twice daily.
For people with penicillin allergies, doctors typically choose from a different class of antibiotics. If you’re prescribed antibiotics, take the full course even if you start feeling better partway through. Stopping early increases the chance that resistant bacteria survive and cause a harder-to-treat infection later.
Symptoms That Need Immediate Attention
Sinus infections rarely become dangerous, but certain symptoms signal that the infection may be spreading beyond the sinuses. Get medical attention right away if you notice swelling or redness around your eyes, double vision or other vision changes, a high fever, confusion, or a stiff neck. These can indicate that the infection has reached the eye socket or the tissue surrounding the brain, both of which require urgent treatment.