What’s the Best Antibiotic for a Sinus Infection?

If you’ve got a sinus infection, you probably want to get rid of it fast. And you may have heard that a Z-Pak can knock it out. But not so fast: A Z-Pak usually isn’t your best option. That’s because most sinus infections are caused by a virus, not bacteria. So, taking antibiotics, like a Z-Pak, won’t help. And, in cases when an antibiotic is recommended for a sinus infection, other medications are typically preferred. 

Let’s take a closer look at when you should use a Z-Pak, and what’s the best antibiotic for a sinus infection.

What are the best antibiotics for a sinus infection?

The antibiotic that’s best for your bacterial sinus infection will depend on your medication allergies and how severe your symptoms are. Your primary care provider can work with you to develop the best treatment plan for your symptoms.

If your primary care provider thinks you need antibiotics to treat your sinus infection, they’ll likely have you start with amoxicillin for up to 10 days. It’s the best choice for most people because it works well and tends to be more affordable than other options. Here are other good choices for antibiotics to treat a sinus infection.

Amoxicillin with clavulanate (Augmentin)

Amoxicillin with clavulanate (Augmentin) is a penicillin-like antibiotic. The clavulanate protects amoxicillin from being broken down by some types of bacteria. This makes it effective against a more broad variety of bacteria than just amoxicillin alone, which is why it’s sometimes recommended over amoxicillin. This antibiotic can treat many types of bacterial infections, including urinary tract infections (UTI), sinus infections, and ear infections. 

Doxycycline 

Doxycycline is a tetracycline antibiotic that can be a good alternative to amoxicillin for people who are allergic to penicillin. Beyond sinus infections, it’s used to treat many conditions, including acne, chlamydia, and UTIs.

Cefixime

Cefixime (Suprax) is a cephalosporin antibiotic that may be used in people who have mild allergic reactions to penicillin. It can treat many different types of bacterial infections, including sinus infections. But it costs more than other similar antibiotics and tends to cause diarrhea and stomach upset. So, it isn’t the go-to option. Also, people with severe penicillin allergies should still avoid cefixime.

Fluoroquinolones, like levofloxacin and moxifloxacin 

Fluoroquinolones are another class of antibiotics that are suitable for people who are allergic to penicillin. Suitable options to treat sinus infections include levofloxacin and moxifloxacin. 

What is a Z-Pak, and what is it used to treat?

A Z-Pak is a 5-day course of azithromycin (Zithromax), an antibiotic. It’s used to treat certain bacterial infections, including some sinus infections and upper respiratory tract infections that lead to: 

• Headaches

• Sore throat

• Congestion

• Runny noses

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When is a Z-Pak good for a sinus infection?

Most sinus infections are viral (and not bacterial), so an antibiotic prescription, like a Z-Pak, won’t actually help. And, even if a healthcare professional determines that you need an antibiotic for your sinus infection, it probably won’t be a Z-Pak. 

The Z-Pak used to be a go-to prescription for sinus infections because it’s easy to use. But, over time, many of the bacteria that cause sinus infections have become resistant to azithromycin. As a result, there’s a good chance that a Z-Pak won’t cure your sinus infection, even if it’s caused by bacteria.

What are the side effects of a Z-Pak?

Z-Pak side effects are usually gastrointestinal, including: 

• Nausea

• Stomach pain

• Constipation

• Diarrhea

Serious side effects — like allergic reactions, liver problems, and dizziness — are rare. But Z-Pak use has been linked to serious heart conditions, like arrhythmias (irregular heartbeat) and increased cardiac deaths.

How do you treat sinus infections without using antibiotics?

Treating a sinus infection comes down to whether it’s viral or bacterial. If it’s viral, antibiotics, like the Z-Pak, won’t work to treat it. In fact, viral sinus infections have no cure. Your primary care provider can help you figure out if your sinus infection is viral or bacterial based on your symptoms and how long you’ve been sick.

Treatment for viral sinus infections aims to manage symptoms and includes:

• Getting plenty of rest

• Drinking lots of fluids

• Inhaling steam from a vaporizer or shower to help you breathe easier

• Using zinc lozenges, which can shorten and lessen the severity of a cold, if you take them in the first 24 hours of having symptoms

What OTC medications can you use for a sinus infection?

If you have a viral sinus infection, the following OTC medications can help relieve your symptoms:

• Pain medications, like acetaminophen (Tylenol) or ibuprofen (Advil), can help with fever, muscle aches, and throat pain.

• Decongestants, like loratadine / pseudoephedrine (Claritin-D) or pseudoephedrine (Sudafed), can help relieve sinus congestion and runny nose.

• Nasal sprays, like fluticasone, can help with inflammation and congestion.

When should I see a doctor for a sinus infection?

You don’t always have to see a healthcare professional for a sinus infection. But, if your symptoms don’t get better after about 7 days, they’re more likely to prescribe an antibiotic. 

Keep in mind that it’s common to feel lousy for several days with a sinus infection. After all, your body is working hard to fight off the infection. You might experience: 

• Runny nose

• Sneezing

• Nasal congestion

• Sore throat

• Cough

• Fatigue

Some people also experience a low-grade fever. Most people begin to feel better within a week, but symptoms can last up to 2 weeks. And a cough can linger for a week after that.

Get medical attention for a sinus infection if you develop any of these symptoms:

• A temperature above 101°F (38.3°C)

• A fever that lasts longer than 2 days

• Severe or persistent headache, ear pain, sinus pain, or chest pain

• Wheezing

• A prolonged or bloody cough

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Written by:

Sharon Orrange, MD, MHS

Sharon Orrange, MD, MHS, is the director of wellness and preventative care at the Ellison Institute of Technology. She's also an associate professor at the University of Southern California's Keck School of Medicine.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Farzon Nahvi, MD, is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works at Concord Hospital in Concord, New Hampshire, and teaches at the Geisel School of Medicine at Dartmouth.

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