Should I use a Z-Pak for Sinus Infections?

tissue box, thermometer, and flu medication
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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“Can I get a Z-Pak?” is a question asked every day by our patients struggling with an upper respiratory infection. Trust me, I want to help you get better, but that’s not always the way to do it.

What is the Z-Pak used to treat?

The Z-Pak (Zithromax), is a five-day course of the antibiotic, azithromycin. It’s used to treat certain bacterial infections, including some sinus infections and upper respiratory tract infections (URIs) that lead to headaches, congestion, and runny noses.

Because it’s so easy to use, the Z-Pak is often a go-to prescription. It can get over-prescribed though, which increases the chance that bacteria will become resistant to azithromycin and that the antibiotic will stop working. Some of us are even guilty of prescribing it for viral, and not bacterial, infections. Since it only works on bacteria, a Z-Pak won’t do a thing for a viral infection.

What are the side effects of a Z-Pak?

Common side effects of azithromycin are usually gastrointestinal, like nausea, stomach pain, constipation, and diarrhea. But serious side effects like allergic reactions, dizziness, and fainting can also rarely happen.

A note about cardiovascular risk: Though the FDA warning from 2013 remains — that current azithromycin use may be associated with an increased risk for ventricular arrhythmia, a type of irregular heartbeat, compared to taking nothing — a 2017 population-based study of over 14 million people found no increased risk of arrhythmia with azithromycin compared to amoxicillin, another commonly prescribed antibiotic.

Should you use a Z-Pak for sinus infections?

First, if you have a upper respiratory infection (URI), expect to feel lousy for several days. After all, your body is waging war against an infection. You might get a runny nose, sneezing, nasal congestion, sore throat, and a cough. You’re also likely to feel more tired and achy, maybe even experience a low-grade fever. Most people improve within a week, but symptoms can last up to two weeks. Coughs can linger for a week after that.

Treating a URI boils down to whether it’s viral or bacterial. Colds, for example, are viral. And antibiotics like the Z-Pak are not effective against viral infections. In fact, viral URIs have no cure. Treatment is aimed at managing symptoms with home remedies like:

There are times you should seek immediate medical care.

If you develop a temp above 101°F or you get a fever that lasts more than two days, you should see a doctor. We’d like to see you if you develop severe or persistent headache, ear pain, sinus pain, or chest pain. Also let us know if you develop a prolonged cough, cough up blood, or develop wheezing.

Hang in there.

Dr O.

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