Key takeaways:
In most cases, sinus infections are viral — not bacterial — infections. So antibiotics like Z-Pak aren’t necessary to treat them.
There’s no cure for viral sinus infections. But you can manage symptoms with over-the-counter (OTC) medications and simple at-home remedies.
When healthcare professionals recommend an antibiotic to treat a sinus infection, amoxicillin is usually the first choice.
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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, along with the best antibiotic for a sinus infection.
What are the best antibiotics for a sinus infection?
If a healthcare professional thinks you need antibiotics to treat a bacterial sinus infection, experts recommend amoxicillin or amoxicillin with clavulanate (Augmentin) as a first-choice treatment. The best choice for you will depend on factors such as your medication allergies and how severe your symptoms are.
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Amoxicillin
Amoxicillin is a penicillin-like antibiotic and a first-choice treatment for most people with bacterial sinus infections. It works well against many of the bacteria that cause sinus infections and tends to be affordable. Amoxicillin is also used to treat other common bacterial infections, such as ear infections and strep throat.
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 gives Augmentin broader coverage than amoxicillin alone.
A healthcare professional may choose Augmentin over amoxicillin for people who are at higher risk for antibiotic-resistant bacteria or who have a more severe infection. It may also be preferred if a sinus infection hasn’t improved with amoxicillin alone.
This antibiotic can treat many types of bacterial infections, including urinary tract infections (UTIs), 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. Good 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 used to treat certain bacterial infections. A Z-Pak may be used to treat infections such as:
Ear infections
Sexually transmitted infections (STI), like chlamydia
When is a Z-Pak good for a sinus infection?
Most sinus infections are viral (and not bacterial). That means 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, a Z-Pak may not cure your sinus infection.
What are the side effects of a Z-Pak?
Z-Pak side effects are usually gastrointestinal (GI), 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:
Using a nasal saline rinse or spray
Getting plenty of rest
Drinking hot liquids like tea and broth
Inhaling steam from a humidifier or shower to help you breathe easier
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 10 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
Sore throat
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
Symptoms that worsen after initially starting to improve
Frequently asked questions
If you have a viral sinus infection, medications often used to treat allergies can help. Symptoms like congestion and inflammation can be treated with:
Decongestants, like loratadine / pseudoephedrine (Claritin-D)
Nasal sprays, like fluticasone
While these allergy medications can help you feel better, remember that there’s no cure for a sinus infection caused by a virus.
Nausea isn’t a common symptom of a sinus infection. However, some allergy medications and antibiotics people use to treat sinus infection symptoms can make you feel nauseous. Nausea is a possible side effect of the decongestant pseudoephedrine and the nasal spray fluticasone. It’s also a common side effect of many antibiotics. If you’re feeling nauseous and aren’t sure why, it’s best to visit a healthcare professional.
Most sinus infections will go away on their own without antibiotics. The best way to know if you need antibiotics for a sinus infection is to visit a healthcare professional. If your symptoms are mild, they’ll likely recommend watchful waiting and tips to help manage your symptoms. If you’ve had symptoms for more than 10 days, they may consider prescribing an antibiotic.
If you have a viral sinus infection, medications often used to treat allergies can help. Symptoms like congestion and inflammation can be treated with:
Decongestants, like loratadine / pseudoephedrine (Claritin-D)
Nasal sprays, like fluticasone
While these allergy medications can help you feel better, remember that there’s no cure for a sinus infection caused by a virus.
Nausea isn’t a common symptom of a sinus infection. However, some allergy medications and antibiotics people use to treat sinus infection symptoms can make you feel nauseous. Nausea is a possible side effect of the decongestant pseudoephedrine and the nasal spray fluticasone. It’s also a common side effect of many antibiotics. If you’re feeling nauseous and aren’t sure why, it’s best to visit a healthcare professional.
Most sinus infections will go away on their own without antibiotics. The best way to know if you need antibiotics for a sinus infection is to visit a healthcare professional. If your symptoms are mild, they’ll likely recommend watchful waiting and tips to help manage your symptoms. If you’ve had symptoms for more than 10 days, they may consider prescribing an antibiotic.
The bottom line
Most sinus infections are caused by a virus, not bacteria. That means antibiotics aren’t necessary, and they can actually do more harm than good. But if your symptoms continue for over 10 days, contact your primary care provider. If they recommend an antibiotic, amoxicillin or amoxicillin / clavulanic acid (Augmentin) are usually at the top of the list.
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References
Kwon, E., et al. (2025). Acute sinusitis. StatPearls.
Payne, S. C., et al. (2025). Clinical practice guideline: Adult sinusitis update. Otolaryngology–Head and Neck Surgery.
Zaroff, J. G., et al. (2020). Association of azithromycin use with cardiovascular mortality. JAMA Network Open.
