If you’ve been knocked out by sinus infection symptoms—stuffiness, face pain or pressure, nasal discharge—your doctor might recommend that you wait it out for a week or so before resorting to an antibiotic. And she or he might be right: Antibiotics are often not necessary for clearing up a sinus infection, according to recent research.

As a result, many health experts, including Zara Patel, M.D., a sinus infection expert and assistant professor of otolaryngology at Stanford University in Stanford, Calif., are urging doctors to think twice before prescribing antibiotics for sinus and other respiratory infections.

A 2016 study, published in JAMA, found that people who went to the doctor with a sinus infection were more likely to leave with a prescription for antibiotics than people seeing the doctor for any other reason (such as a sore throat or an ear infection). But some doctors, pointing to newer evidence, are starting to take a more cautious approach.

“For acute sinusitis, there are very well-done studies indicating that antibiotics are not necessary in the vast majority of patients, and most people will be able to clear an infection on their own,” Patel says.

Understanding Sinus Infections

Sinus infections, or sinusitis, usually stem from a viral infection, not a bacterial one—and antibiotics don’t work against viruses.

Even when bacteria does cause your sinusitis, it usually clears up on its own without drugs, according to Choosing Wisely treatment guidelines, which were developed with the American Academy of Allergy, Asthma & Immunology (AAAAI).

More on Antibiotics

In a study of 166 adults with acute sinusitis published in JAMA, the antibiotic amoxicillin proved no better than a placebo at reducing symptoms after three days.

According to the AAAAI, taking antibiotics will not help you feel better—and might have unpleasant side effects that could leave you feeling worse.

The AAAAI treatment guidelines suggest that nearly 25 percent of people who take antibiotics experience side effects, most commonly diarrhea, stomach problems, and rashes. Even more concerning is that these drugs also contribute to the spread of resistant superbugs, which sicken at least 2 million people in the U.S. every year. 

Feel Better Sooner Without Antibiotics

Instead of taking antibiotics for sinusitis, Consumer Reports’ chief medical adviser, Marvin M. Lipman, M.D., recommends that you get plenty of rest, rinse your nose with a saltwater sinus rinse or spray, drink warm fluids, and inhale steam from a hot bath, shower, or kettle. For pain, he says, try an over-the-counter pain reliever such as acetaminophen (Tylenol or generic) or ibuprofen (Advil or generic).

If needed, your doctor can prescribe a prescription corticosteroid spray, such as fluticasone or triamcinolone. A systematic review published in JAMA in 2015 found that after saline irrigation, the second-best treatment for chronic sinusitis was a topical corticosteroid spray for a few days. 

When to Consider Antibiotics for Sinus Infections

AAAAI advises that antibiotics for sinus infections should be considered only if you develop a fever of 102° F or higher, you have severe face pain and tenderness, your symptoms last longer than a week or so, or your symptoms improve and then worsen again.

“Some patients with acute sinusitis do need antibiotics, and if they continue with a worsening infection without treatment, they can suffer dramatic complications such as loss of vision, meningitis, or brain abscess,” Patel says.

If your doctor says you need an antibiotic, ask for generic amoxicillin/clavulanate, according to guidelines from UpToDate, which provides evidence-based treatment information to healthcare providers. It’s usually the best choice and works as well as more expensive brand-name antibiotics.

Avoid taking fluoroquinolones, a group of antibiotics that includes ciprofloxacin (Cipro) and levofloxacin (Levaquin). Although widely used, the antibiotics are inappropriate for treating sinus infections and they pose serious risks.

In 2016, after a safety review, the Food and Drug Administration linked fluoroquinolones to disabling and potentially permanent side effects. The agency advised against using the drugs to treat common illnesses—bronchitis, sinus infections, and urinary tract infections. 

Editor’s Note: These materials were made possible by a grant from the Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).