How to Treat a Sinus Infection [The right way]

How to Treat a Sinus Infection – The right way!

Woman sick with sinus infection
Learn how to treat a sinus infection the RIGHT way!


Sinus infections suck!

I understand what you’re going through.  You start off with your typical cold symptoms:  a little stuffy or runny nose or a sore throat.  For most of your friends, this will be just a few days of feeling sick and then they’re better.  They don’t understand what you’re about to go through.Your nose congestion is going to get worse.  Then you start to feel the fullness behind your eyes and cheeks, the start of a headache, and you know that every virus and bacteria are fighting for their right to party in your sinuses.  And it keeps getting worse.

Soon, your headache will be relentless and worsen with every cough and head movement as well as every bump and hill you go over.  Your sleep will be nonexistent.  And should you bend over to tie your shoe… rage to anyone near you!

But what you do next is what I can help with:

  • What can you do at home to treat your sinus infection?
  • When do you go to the doctor?
  • When do you ask for antibiotics?


Treat sinusitis the right way!

It is not complicated to treat a sinus infection, but it is often done incorrectly by both patients and medical providers.  The problem:  treating sinusitis the wrong way can cost you time and money!

Treat sinusitis the wrong way and you’ll be wasting time AND MONEY!

To help, I have put together this “How to Treat a Sinus Infection” guide to help you treat sinusitis the right way and, in doing so, help you save money!

Warning:  This is a long post with a lot of great tips!   

To make your life easier, you can download the post and keep this guide with you.  I promise your “How to Treat a Sinus Infection” pocket guide will be the gift that keep on giving!

Download your “How To Treat a Sinus Infection” pocket guide


Before we begin, do you really have a sinus infection?

If you are someone who has had frequent sinus infections, this step may seem ridiculous.  But if you this is relatively new for you, it is important to make sure you have the right diagnosis before you start to treat sinusitis.

I’ve written this post to help you try and sort out your symptoms.  Please take a moment to read through it and make sure you have the right diagnosis (and if you have any questions, feel free to ask me and I’ll be happy to help).

Once you confirm that your diagnosis, we can move on and discuss how to treat a sinus infection.

Treat sinusitis AFTER you have the right diagnosis
First make sure you have the right diagnosis!

How to Treat a Sinus Infection – Step 1

–The Importance of Time–

If I had to go through ONE thing before I lost your attention, it would be the importance of time (symptom duration) in guiding proper treatment.

As a general rule, most sinus infections start off as a viral infection and this viral phase lasts for about 10-14 days.  What this means to you is:

  • For 2 weeks, you need symptomatic treatment only
  • Antibiotics WILL NOT HELP during this time
  • If you see your provider during this time and they give you antibiotics:
    • They will still not help during the viral phase
    • You likely wasted time and money
  • There are some studies that show this phase may be more like 21 days, particularly for children!


Best tip for how to treat a sinus infection:  The first 2 weeks are viral and symptomatic treatment is the only way to treat a viral sinusitis.  Antibiotics at this point do NOT help.

Let me answer some of the questions you probably asked yourself you read this:

  • If you have a fever, even a high fever – it does not matter.
    • Both viral and bacterial sinus infections can cause fever.
    • Only duration of symptoms matter in treating a sinus infection


  • If you have white mucous, or green mucous, or yellow mucous – it does not matter.
    • Both viral and bacterial sinus infections can cause mucous of all colors
    • Only duration of symptoms matter in treating a sinus infection


  • If you have a severe headache or severe sinus pain or pressure – it does not matter.
    • Both viral and bacterial sinus infections can cause severe headaches as well as severe sinus pain or pressure.
    • Only duration of symptoms matter in treating a sinus infection!


  • Finally, if you have tooth pain – it does not matter.
    • Both viral and bacterial sinus infections can cause tooth pain.
    • ONLY DURATION OF SYMPTOMS matter in treating a sinus infection


I am not writing this in a repetitive manner just to be a jerk.  Also, your symptoms do matter to me from the point of view that I want you to feel better.

But as a generalization there is no magical phrase, symptom or temperature that tells you this is a bacterial infection and in need of antibiotic.  Time is the major deciding factor!  So let me save you time and your money:  start with these viral sinusitis treatments during the first 14 days of your sinus infection.


How to Treat a Sinus Infection – Step 2

–Over the Counter Symptom Relief from Viral Infections–



Yeah, yeah, I know — “drink plenty of fluids” is a doctor cliché.  But when you want to treat a sinus infection, hydration is very important!  Mucous is being made in response to the viral infection but since it is so thick it helps keep your sinuses congested and makes draining difficult (which, in turn, causes your sinus pain and pressure).

Fluids help reduce the thickness of the mucous and help it drain easier!

Thinner mucous helps reduce sinus pain and pressure as well as helps reduce the sore throat you may get when all that mucous drains down your throat (a very unpleasant thought and surprisingly gross to type.  But still, fluids help significantly)!

Guaifenesin (Mucinex, Robitussin, or any generic or derivatives of guaifenesin)

Guaifenesin is a great over the counter medication that that also helps thin the mucous (and helps you clear it out of your body).

It gives you a lot of the same benefits mucous-thinning benefits as hydration – and when you add both together they can do a lot to help reduce your sinus pain and pressure!

Sinus Rinse (like a Neil-Med, Netti-pot or similar rinse)

Graphic showing most people tolerate sinus rinse when treating sinusitis
Treat a sinus infection with a sinus rinse

Sinus rinses are a great addition to help treat a sinus infection… if you can tolerate them.  They are NOT a medication and they just help get all the mucous, debris and other irritants out of your nose!

I add the “if you can tolerate them” because a lot of people would rather eat pieces of broken glass than use a sinus rinse.

Sinus rinses are just one of those things that you will either tolerate or you won’t.  But if you can, then it is a great non-medication to help treat a sinus infection.

Pseudoephedrine (Sudafed, Walphed, etc)

If your nose is really stuffy and congested OR if you have a lot of sinus pain or pressure, then I would recommend adding a decongestant.  In this category, the best is probably real pseudoephedrine!  I’m not talking real like name brand Sudafed because generic is just as good.  But you DO need to get the pseudoephedrine from behind the pharmacy counter.

If you want to get pseudoephedrine:  generic is ok (and what I buy) but make sure you get the “good stuff” behind the pharmacy counter.  Just show your license, promise not to turn it to meth, and then enjoy some sinus pressure relief!

Remember, if you have high blood pressure then pseudoephedrine might raise your blood pressure.  Check with your provider before taking it and keep an eye on your blood pressure.  Or choose one of the blood pressure safe decongestants.

Nasal steroids (Flonase/fluticasone, Nasonex/mometasone, Rhinocort/budesonide, Nasacort/triamcinolone)

Let me save you money on this one:  don’t buy a nasal steroid to treat a sinus infection!

These medications are great for treating allergies and have a good role in treating chronic sinusitis.  But since they can take 4-6 weeks to reach full strength, they are of limited value for treating a sinus infection.

Oxymetazoline (Afrin)

I do NOT recommend this medication for treating a sinus infection.  It can reduce congestion in your nose, but you can only take it for 3 days before it starts causing a potential “nose addiction” to the mediation (known as rhinitis medicamentosa).

Most sinus infections last a lot longer than 3 days so this medication will give you temporary relief for a very, very short amount of time and then set you up for a disappointment later when you need to stop using it.


How to Treat a Sinus Infection – Step 3

–Prescription Medications for Viral Infections–

If the over the counter symptoms are not enough but you are still in the viral stage of a sinus infection, there are two prescriptions to help treat a sinus infection:  nasal Atrovent (ipratropium bromide) and Astelin (azelastine).

I tend to save these medications for people who have tried everything else and need something… anything… to help.  They each have a specific purpose and do that purpose well.

But overall, if I you were to ask me if making an appointment and a copay is worth it to get these medications–I’d say no.  The benefits they provide to treat a sinus infection are not that much more than the over the counter treatments.

Nasal Atrovent (ipratropium bromide)

Nasal atrovent is best used for a runny nose, which can often happen at the same time as a sinus infection.  So if you want to treat a sinus infection’s runny nose then consider this medication.  However, it will have limited benefit for a stuffy nose or for sinus pain/pressure.

Astelin (azelastine)

This is a topical antihistamine.  It is AMAZING to use for treating allergies, irritant rhinitis, mixed rhinitis, chronic sinusitis and helps with allergic asthma.  It is also even more impressive when combined with a nasal steroid!

But to treat a sinus infection… it’s just ok.

The problem is that there is minimal if any histamine involved in a sinus infection so while this nose spray might help a little with the runny nose and a little with the stuffy nose, it is not what I would reach for if I had to pick one medication to treat a sinus infection.

Man with bacterial sinus headache
Read below to know when you have a bacterial sinusitis

How to Treat a Sinus Infection – Step 4

–Know when you have a Bacterial Sinus Infection–

If you have had symptoms for longer than 10-14 days you very likely have a bacterial sinusitis.  I’ve heard different descriptions of what actually causes a bacterial sinus infection, but the one that makes the most sense to me is the theory of bacterial transformation.

Bacterial transformation says that usually a viral infection starts the sinus infection and, either because of the persistent mucous environment in your sinuses OR that the viral infection weakened your immune system’s response, a bacteria is then able to take over.

Typically, I tend to think you have a bacterial sinus infection when:

  • You often start to feel better and your viral infection is getting better BUT THEN it starts to get worse again!
  • You have a CHANGE in mucous color/consistency. In this scenario, you may have a white colored mucous at first but then it changes to a green, or a yellow, or if it was one of those and changes to white!  The CHANGE is what is important.
  • Again, time duration lasting longer than 10-14 days.


In these cases, I still recommend each and every step above.  It’s great a great way to treat a viral or bacterial sinus infection.  But if you have a bacterial transformation, you often need to add an antibiotic.

THIS is the time to make an appointment with your provider!


Pick the right antibiotic treatment for bacterial sinusitis
Pick the right antibiotic the FIRST time!

How to Treat a Sinus Infection – Step 5

–Add an Antibiotic for Bacterial Sinus Infections–

Antibiotics are needed to treat a bacterial sinusitis.  But there are some antibiotics that are good and some that are not good to treat a sinus infection.  I get a lot of consults for people who think they have allergies after an antibiotic failed to clear their symptoms who are NOT allergic, but were actually given the wrong antibiotic.

So here is the best evidence-based antibiotics to treat a sinus infection:

Bacterial sinusitis treatment #1 – Amoxicillin-Clavulanate (Augmentin)

If you are able to take a penicillin, then Augmentin (amoxicillin-clavulanate) is the treatment of choice for a bacterial sinus infection.  It is a penicillin with an antibiotic-resistance fighting component and is what I try to give all my patients if I am able.

The dosing varies based on age as well as resistance in your area, but this should be your go to antibiotic to treat a sinus infection.  It does have one problem:  big pills!

If you have problems swallowing large pills, I’d recommend pricing out the liquid version given to younger children as a first choice and changing antibiotics as a second choice.

Bacterial sinusitis treatment #2 – Doxycycline

If you have an allergy to penicillin then the next alternative is a medication called doxycycline.  It is a great antibiotic and does a good job of treating sinus infection.  For some people it can cause an upset stomach or loose stools, but for the most part it is well tolerated (plus, tiny pills)!

Bacterial sinusitis treatment #3 – Cephalosporins or Clindamycin

If you are allergic to multiple medications then you can consider one of these two alternatives.

Cephalosporins might be an antibiotic class you can ask your provider to try to treat a sinus infection.  But know that 7-10% of people with a penicillin allergy also have a cephalosporin allergy.  Make sure you ask your provider whether or not this is a possible treatment choice for you  (note:  as a general rule, if you are penicillin allergic you should also avoid this class of antibiotic).

Clindamycin is another alternative if you have a lot of allergies.  Clindamycin is a wonderful antibiotic that will destroy your sinus infection.  It might cause an upset stomach, loose stools or a secondary intestinal infection called C. diff (technically, any antibiotic can cause this, but Clindamycin has been associated with it historically).  Still, these are rare complications and this antibiotic WILL treat a sinus infection.

Bacterial sinusitis treatment #4 – Fluoroquinolones (Levofloxacin or Moxyfloxacin)

This class of antibiotics is simply amazing!  They work extremely well for sinuses and are a great choice if you have other medication allergies.  They are typically once a day (as opposed to twice a day), small tablets, and minimal stomach aches or related side effects.

They do have a potential side effect and black box warning of causing spontaneous tendonitis/tendon rupture in a subset of patients (largely those at the extreme of age or who are taking chronic daily prednisone) so you should discuss this with your provider before accepting this antibiotic.  But this antibiotic really does a good job to help you feel better fast!

The only reason it isn’t used sooner in the treatment pathway is that it is a fairly strong antibiotic and, as antibiotic resistance increases, should be saved for those who have no other treatment options.

Bacterial sinusitis treatment #5 – NOT A ZPACK!

I started with the first 4 treatment options to show that almost everyone can take at least ONE type of antibiotic to treat a bacterial sinus infection that is NOT a zpack (azithromycin).

Azithromcin (z-pack) is NOT recommended as empiric treatment for a bacterial sinusitis.

Zpacks / azithromycin is given to patients quite often to treat a sinus infection.  It is a convenient antibiotic and it doesn’t cause a lot of side effects.  And it is WRONG!

The most common causes of bacterial sinusitis are increasingly resistant to this antibiotic.  So if you take it there is a very high chance your sinus infection will NOT be treated.

This isn’t just me ranting against antibiotic resistance.  It is also a financial issue which I cover in more detail below.  What I can tell you is that if I had a sinus infection and needed treatment, I would not take this medication.

Don't use a zpack for treating sinusitis
Yay! I DIDN’T pick a Z-pack! I saved my patients time and money!

How to Treat a Sinus Infection – Step 6

–The Financial Cost of Inappropriate Treatment–

I put this section at the end because back in grade school I was taught to end an argument with a strong closing point (a skill that Emmett has already learned at age 6).  But even if you thought I was full of it up to this point, this should make it a lot more clear:

Note:  For costs, I am estimating everything since America has such screwed up health care pricing that I can’t guess any true price (Canada, I wish I were a part of your system)!  But I’ll be consistent so the comparison will work out correctly:

Proper Treatment

TreatmentIndividual CostTotal
· Viral treatment OTC meds· Cost of OTC meds ($20)$20
· Viral treatment OTC meds
· See Doctor after 14 days with proper antibiotic
· Cost of OTC meds($20)
· Cost of doctor ($50)
· Cost of correct antibiotic ($20)


Improper Treatment

TreatmentIndividual CostTotal
· Viral treatment OTC meds
· Seeing a doctor to tell you it’s viral
· Cost of OTC meds ($20)
· Cost of doctor ($50)
· Viral treatment OTC meds
· See a doctor and being given an antibiotic when you don’t need it
· Cost of OTC meds($20)
· Cost of doctor ($50)
· Cost of incorrect antibiotic ($20)
· Viral treatment OTC meds
· Seeing a doctor and being given an antibiotic when you don’t need it
· Seeing a doctor back after 14 days when you actually need an antibiotic
· Cost of OTC meds ($20)
· Cost of doctor ($50)
· Cost of incorrect antibiotic ($20)
· Cost of return visit ($50)
· Cost of new antibiotic ($20)
· Viral treatment OTC meds
· Seeing a doctor after 14 days
· Getting the wrong antibiotic
· Seeing a doctor back when it doesn’t work
· Getting a new antibiotic
· Cost of OTC meds ($20)
· Cost of doctor ($50)
· Cost of incorrect antibiotic ($20)
· Cost of return visit ($50)
· Cost of new antibiotic ($20)
· Viral treatment OTC meds
· Seeing a doctor after 14 days
· Getting the wrong antibiotic
· Seeing a doctor back when it doesn’t work
· Being told its an allergy when its an antibiotic failure
· Seeing an allergist (who inappropriately does a full allergy test)
· Getting an appropriate antibiotic
· Cost of OTC meds ($20)
· Cost of doctor ($50)
· Cost of incorrect antibiotic ($20)
· Cost of return visit ($50)
· Cost of allergist ($600)
· Cost of correct antibiotic ($20)

*And this, America, is why our Healthcare costs so damn much!  Plus the crazy high CEO salaries, the inefficiencies of insurance companies, the lack of proper gate keepers, the monetary reward of doing procedures and not in appropriate diagnosis, and more that I could probably go through but I am kind of tired of this rant.

Treatment thanks to this guide

TreatmentIndividual CostTotal
· Viral treatment OTC meds· Cost of OTC meds ($20)$20
· Viral treatment OTC meds
· See Doctor after 14 days with proper antibiotic
· Cost of OTC meds ($20)
· Cost of doctor ($50)
· Cost of correct antibiotic ($20)

Again, I know these costs vary.  For some people they don’t have a fixed copay but pay a percentage.  For some people different visits cost different amounts.  For my friends in Canada, the cost is a lot less (man, your country really does have its S&^t together) but WAIT TIME is an issue… so picking the right path will save you time.


How to Treat a Sinus Infection – Step 7

–My Approach as an Allergist–

I don’t probably need a step 7, but John Elway (the greatest Denver Bronco of all time) was #7 and as a result all great lists should have 7 points (which is ALSO the number of points in a touchdown+extra point… and John Elway scored 300 touchdowns in his career… so this is another good reason to have a step 7).

So to honor John Elway, here is how I approach chronic sinusitis in my patients:

  • If they call or email me with suspected symptoms, I will give them the exact same list I gave you. No charge (why would there be)?  Just helpful information.
  • If they come to see me during the viral stage, I give them the list I just gave you and will NOT give an antibiotic. BUT if their symptoms last longer than 10-14 days I just call in an antibiotic and don’t double charge.
  • If they are sent to me an as allergy referral I will usually treat the sinus infection without doing additional testing and will pick the right antibiotic the first time. Because why would I contribute to the outrageous cost of healthcare?


And that’s pretty much it.  I only type this to show that it really isn’t that hard to provide high quality care WITHOUT jacking up the cost of referrals, doing inappropriate tests or causing unnecessary return visits.


Final Thoughts

I know this was a long post.  And fairly boring… I think I fell asleep once typing it.  So if you skimmed through all of it and want a copy to reference in the future you can download it here:

Download your “How To Treat a Sinus Infection” pocket guide

If you stayed awake and thought this was helpful, consider sharing it with your friends.  Or printing it out through the link above and sharing that.  I would love it if I could help everyone treat a sinus infection better, faster, and without unnecessary costs.



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  1. I really like your advice to make sure that you are staying well-hydrated. There are a lot of people that don’t understand the difference that water makes to your health. The last thing you want is to cause your health to continue to deteriorate due to dehydration. Do you have any other tips for dealing with sinuses?

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