Most sinus infections are viral and clear up on their own within 7 to 10 days, so what you “take” is primarily a combination of over-the-counter medications to manage symptoms while your body fights the infection. Antibiotics only help in the minority of cases that are truly bacterial. The right approach depends on how long you’ve been sick, how severe your symptoms are, and whether they’re getting better or worse.
Why Most Sinus Infections Don’t Need Antibiotics
The overwhelming majority of sinus infections start as viral illnesses, and antibiotics do nothing against viruses. Colored or thick nasal discharge, facial pressure, and even low-grade fever are not reliable signs of a bacterial cause. Many people assume green mucus means they need antibiotics, but that’s simply how your immune system responds to any infection, viral or bacterial.
Antibiotics should only be considered when symptoms meet specific thresholds: at least 10 days of symptoms with no improvement, symptoms that seem to get better around day 5 or 6 and then suddenly worsen, or severe symptoms like a fever of 102°F or higher with facial pain and thick nasal discharge lasting at least 3 to 4 days. If your symptoms don’t fit any of those patterns, you’re almost certainly dealing with a viral infection that will resolve with supportive care.
Over-the-Counter Pain Relievers
Facial pain and pressure are often the most miserable part of a sinus infection. Standard pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) both work well. Ibuprofen has the added benefit of reducing inflammation, which can help with swelling in the sinus passages. Combination products marketed as “sinus” formulas typically pair acetaminophen with a decongestant, so check the label carefully to avoid accidentally doubling up on acetaminophen if you’re already taking it separately. The maximum daily dose of acetaminophen for adults is generally around 3,000 to 3,250 mg, and exceeding that puts your liver at risk.
Decongestants for Congestion and Pressure
Oral decongestants containing pseudoephedrine are the most effective option for relieving nasal congestion and sinus pressure. Adults can take 60 mg every 4 to 6 hours, up to 240 mg per day. Pseudoephedrine is kept behind the pharmacy counter in the U.S. (you’ll need to show ID), but it doesn’t require a prescription. It can raise blood pressure and cause jitteriness, so it’s not a good choice if you have hypertension or anxiety.
Nasal decongestant sprays containing oxymetazoline (Afrin) provide fast relief but should not be used for more than 3 consecutive days. Beyond that, they cause rebound congestion, where your nose becomes more blocked than it was before you started using the spray.
Nasal Steroid Sprays
Over-the-counter nasal corticosteroid sprays like fluticasone (Flonase) and mometasone (Nasonex) reduce inflammation in the sinus passages and are one of the most effective treatments for sinus infection symptoms. Clinical trials have shown that nasal steroids significantly reduce headache, congestion, and facial pain. In one study, a nasal steroid spray used twice daily actually outperformed the antibiotic amoxicillin for symptom relief, without increasing the risk of prolonged infection or recurrence.
These sprays work best when used consistently rather than as needed. They take a day or two to reach full effect, so starting early in the course of your infection gives you the most benefit. Unlike decongestant sprays, nasal steroids are safe for extended use.
Saline Nasal Rinses
Rinsing your sinuses with salt water is one of the simplest and most consistently helpful things you can do. A neti pot, squeeze bottle, or bulb syringe flushes out mucus, allergens, and irritants directly from the sinus passages. You can buy pre-mixed saline packets or make your own solution.
The one critical safety rule: never use plain tap water. Tap water can contain organisms, including a rare but dangerous amoeba, that are harmless if swallowed but potentially fatal if introduced into the nasal passages. The CDC recommends using distilled or sterile water from a store, or tap water that has been boiled at a rolling boil for at least 1 minute (3 minutes at elevations above 6,500 feet) and then cooled. If neither option is available, you can disinfect water with a few drops of unscented household bleach: about 5 drops per quart for standard-concentration bleach, stirred and left to stand for 30 minutes before use.
Steam, Fluids, and Other Home Measures
Steam inhalation helps loosen thick mucus and eases facial pain. Draping a towel over your head and breathing in steam from a bowl of hot water works, as does simply standing in a hot shower. The relief is temporary but can make a real difference when you’re most congested.
Staying well hydrated helps dilute mucus secretions so they drain more easily. Water and juice are ideal. Alcohol worsens the swelling of sinus and nasal linings, and caffeinated drinks can be dehydrating, so both are worth limiting while you’re sick. Sleeping with your head slightly elevated can also help sinuses drain overnight rather than pooling and worsening pressure.
When Antibiotics Are Appropriate
If your symptoms have lasted at least 10 days without improvement, or if they worsened after initially getting better, your doctor may prescribe antibiotics. The typical first-choice antibiotic is a penicillin-type medication taken for about 5 days. If symptoms don’t improve after 2 to 3 days on the first antibiotic, a stronger combination antibiotic is usually the next step. For people with a penicillin allergy, alternatives are typically chosen in consultation with a specialist based on local resistance patterns.
Even when antibiotics are warranted, continuing with nasal steroid sprays, saline rinses, and pain relievers alongside them improves outcomes. Studies show that adding a nasal steroid to antibiotic therapy produces greater symptom improvement than antibiotics alone.
Symptoms That Need Immediate Attention
Most sinus infections are uncomfortable but not dangerous. Rarely, infection can spread to nearby structures like the eye socket or the brain. Go to an emergency room if you develop pain, swelling, or redness around your eyes, double vision or other changes in your eyesight, a high fever that isn’t responding to treatment, confusion, or a stiff neck. These symptoms can signal a serious complication that requires urgent treatment.