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Antibiotics - When You Need Them for a Sinus Infection and When You Don’t

Written by Lindsey Mcilvena, MD, MPH on November 8th, 2019

How do you know when you need to take antibiotics for a sinus infection?

I just need a Z-pak, I get this every year.

I know my body, it’s bronchitis.

I’ve only had it for two days, but I need an antibiotic to knock it out.

After a decade of practicing medicine, I’ve heard it all. I get it--when you’re sick and miserable, getting a prescription for an antibiotic seems like it could be the fastest and easiest way to get better. Unfortunately, in most cases of upper respiratory infection, an antibiotic isn’t a good idea and here’s why:

Antibiotics only work for bacteria; the vast majority of colds and upper respiratory infections that strike (in any season) are due to viruses. Because of their microscopic structure, antibiotics can’t do anything to keep viruses from multiplying and spreading.

Antibiotics can make you sicker in the long run. Some patients have suggested just taking the antibiotic, even when it’s a virus, just in case there is a small bacterial component. The trouble with this is that taking an antibiotic when it’s not warranted actually puts you at risk for more upper respiratory illnesses in the next year. The mechanism, while not exactly clear, is likely because the antibiotic wipes out a substantial part of your good bacteria--a vital part of your immune system.

Inappropriate antibiotic use leads to resistance. In my time in the ICU during internship and residency, I saw countless patients who had acquired drug-resistant bacterial infections and were in a life-threatening situation. This was scary--the infectious disease specialists would recommend using the biggest, baddest antibiotics we’ve got, and sometimes they still didn’t work. Bacteria are smart, they figure out ways to avoid being killed by antibiotics. It’s essential to safeguard the effectiveness of our antibiotics to give these bacteria less opportunity to morph into superbugs.

But, there are some cases where antibiotics are a good idea, so keep reading.

Strep Throat

Symptoms typically include a very sore throat along with a fever of 101 or greater, sore glands (lymph nodes) under your jaw on the side of your neck, tonsils that are bright red or have white patches (exudates). It’s doubtful that it’s Strep throat if you have a cough, runny nose, or congestion along with the other symptoms. Strep throat is actually less likely in adults than in children.


This type of chest infection is not one to mess with--it can be life-threatening, particularly in young babies and older adults. Symptoms typically include a fever of 101 or higher, cough, pain in the chest when inhaling, extreme fatigue, and shortness of breath. If you’ve got these symptoms a trip to urgent care or your PCP (if you can get in the same day) is essential.

Some Ear infections

This one has caveats. Viral and bacterial ear infections can cause ear pain and congestion, fever, and may come with a cough or a runny nose. The only way to know if an antibiotic is needed is to have a doctor actually look inside your ear with an otoscope. If there’s a collection of pus behind the eardrum, then antibiotics are in order. Otherwise, it will usually clear up with Tylenol, ibuprofen, and time. Bacterial ear infections are much more common in children, but they can happen to adults as well.

Some Sinus infections

These pesky infections cause congestion, headaches, facial pain and pressure, and lots of mucus drainage. Most of the time antibiotics are not needed because sinus infections typically start out viral. Some people are unlucky enough to contract a bacteria as a secondary infection. If you have any of the following, it’s more likely to be bacterial and warrant an antibiotic: fever of 101 or higher, severe facial pain that has been present at least 4-5 days, sickness for about a week - where you felt a significant improvement and then got much worse, or symptoms that have persisted for more than 10-14 days.

For most of the other cases of a cough, cold, bronchitis, sore throats, the sniffles, head colds, and upper respiratory infections, it’s a matter of getting rest, taking medications to alleviate symptoms, and riding it out. When in doubt (especially with children, older adults, and those with underlying medical conditions), it’s a good idea to see a doctor.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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