Sinus infection medicines: antibiotics, decongestants and rinses

A sinus infection is inflammation of the sinuses, and most of the time a virus causes it, the same kind that causes a cold. So first-line treatment is about keeping you comfortable while your body recovers: saline rinses, pain relievers, fluids, rest and, in some cases, a nasal steroid spray. The CDC explains that many sinus infections get better without antibiotics, and that antibiotics do not work on viruses.

This guide explains what each kind of medicine does, what precautions come with it, and when it makes sense for the doctor to assess whether an antibiotic is appropriate. For what a sinus infection is and its symptoms, see sinus infection: treatment by video.

Rinsing the nose with salt water helps clear thick mucus and keeps the nasal passages moist. You can use a saline spray or dropper, a nasal syringe or a squeeze bottle. It is a low-risk home care step you can combine with any other treatment.

Use the right water. To make the solution, use distilled or sterile water, or water you have boiled for 3 to 5 minutes and let cool. Untreated tap water is not safe for the nose because it can contain microorganisms that are harmless to swallow but dangerous when they enter through the nose. Wash the device with safe water after every use and let it air dry.

If rinsing hurts or gives you ear pain, stop and tell the doctor. For small children, ask before using a pressured rinse; saline drops or spray are usually easier.

Steroid nasal sprays (such as fluticasone or mometasone, some sold without a prescription) reduce inflammation inside the nose. They can help most when the sinus problem comes with allergies or keeps coming back. They take several days to work and are used every day, not only when you feel bad. If your symptoms look more like allergies than a cold, see allergies.

Antihistamines help with the itching, sneezing and runny nose of allergies. They are not a routine treatment for a sinus infection and can dry out mucus and make it harder to clear, so do not use them blindly.

Decongestants relieve a stuffy nose, but they come with important precautions. Here are the most common types:

Acetaminophen (Tylenol) or ibuprofen help with pain and fever. Follow the label dose and its warnings if you have kidney, stomach or liver problems or take blood thinners. Children and teens should not be given aspirin. If the headache is very severe, the worst you have ever had, or comes with other warning signs, see headache. For a stuffy nose that is not a sinus infection, see stuffy nose.

Most acute sinus infections are viral, and both the IDSA guideline (2012) and the CDC agree that an antibiotic is not the starting point for most people. According to the CDC, a bacterial infection is more likely in these situations:

Green or yellow mucus does not mean by itself that you need an antibiotic: the color also changes in viral infections. What counts is how long you have had symptoms and how they have changed.

When the doctor decides an antibiotic is appropriate, guidelines use amoxicillin or amoxicillin-clavulanate as the first choice in most cases. If you are allergic to penicillin, tell her before anything is prescribed so she can pick another option. Sometimes the best decision is to watch a few more days before starting. We do not promise an antibiotic before assessing you. To see how this works, read antibiotics by telehealth.

If the doctor prescribes an antibiotic, take all of it as directed and tell her if you are not getting better. Do not save antibiotics for later or take someone else's.

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This helps the doctor decide quickly and safely:

The doctor sees children of all ages. For children, the CDC advises either watching or prescribing depending on how long and how severe the symptoms are, and the dose is based on weight. Patients under 21 need a parent or legal guardian on camera with photo ID. See online doctor visits for kids.