Signs of sinus infection getting better with antibiotics

Nasal congestion and swelling, facial pressure, pain, fever, too much mucus. Ugh. It’s probably another sinus infection. Or is it? And is your infection caused by a virus or bacteria — and does it really matter?

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

It does, says otolaryngologist Raj Sindwani, MD. Doctors treat viral and bacterial sinus infections very differently. Here’s what you need to know about both kinds of infections and how to treat them.

Viral or bacterial?

Sinusitis happens when your sinuses — the normally air-filled pockets in your face — become inflamed and blocked. Most sinus infections are viral. How can you tell whether your infection is viral or bacterial based on your symptoms?

“You can’t,” says Dr. Sindwani.

“Symptoms like bad breath, yellow or green mucus, fever and headache are not reliable signs of a bacterial infection,” he says. “They can occur with viral infections, too. Even your doctor can’t tell if your infection is viral or bacterial based solely on symptoms or an exam.”

Instead, your doctor looks largely at symptom duration to determine the source of your infection. A viral sinus infection will usually start to improve after five to seven days. A bacterial sinus infection will often persist for seven to 10 days or longer, and may actually worsen after seven days.

Some steps you can take

Whether your sinus infection turns out to be viral or bacterial, you can help to ease your symptoms early on with supportive sinus care:

1. Use saline spray two to three times per day in each nostril.
2. Use a nasal decongestant such as Afrin®, but not longer than three days.
3. Drink eight 8-ounce glasses of fluid per day.
4. Get plenty of rest.
5. Take an over-the-counter anti-inflammatory, such as acetaminophen or ibuprofen to help relieve the swelling of your sinuses. 

If your symptoms aren’t improving after one week, it’s important to see your doctor. If a bacterial infection is suspected, you’ll probably need to take an antibiotic to clear up the infection and prevent further complications. 

“If your infections occur more frequently, and your doctor really wants to establish if they are bacterial or viral, your Otolaryngologist or ear, nose and throat doctor can sample the snot from your nose when you’re infected and send it to a laboratory to know for sure.

Note: Antibiotics won’t help a viral infection, and taking an antibiotic unnecessarily can do more harm than good. You risk possible side effects and increase your chances of developing antibiotic resistance, which can make future infections harder to treat, says Dr. Sindwani. So it’s important to wait and see how long your symptoms last.

What to do for chronic sinusitis

If you’re suffering from chronic sinusitis (nasal congestion, drainage, facial pain/pressure, and a decreased sense of smell lasting 12 weeks or longer) or you are getting frequent sinus infections you should see your doctor, says Dr. Sindwani.

Your doctor will swab your nose to collect mucus. Culturing it in a laboratory will reveal which type of bacteria is causing the infection so the right antibiotic can be prescribed.

Treat early sinus infection symptoms with rest, hydration and over-the-counter sprays and decongestants. But don’t look for an antibiotic unless your illness extends beyond a week, he says. Then check in with your doctor for a prescription and let him or her know if your condition worsens.

Sinus infections, or sinusitis, is an inflammatory condition that causes a lot of irritating pain in the sinus area. It can be either a viral or bacterial infection. Many people who have experienced a sinus infection described it as an uncomfortable, annoying feeling within their nasal passages. While most sinus infections can go away on their own, there are some cases of them becoming serious. Here are some warning signs that you must take note of.

Is it a Cold or a Bacterial Sinus Infection?

A good way to identify a sinus infection becoming serious is finding out what type of sinus infection you have. A sinus infection could be viral or bacterial. Swabbing inside of the nose and growing culture is recommended to test which type it is. Viral sinus infections can normally be treated with liquids, rest, and an anti-inflammatory such as ibuprofen. However, bacterial infections are considered to be more lingering and will need to be treated by your doctor.

Chronic Sinusitis and the Symptoms

Chronic sinusitis is a type of sinusitis that usually lasts longer than 12 weeks. People with allergies and other immune problems such as asthma are the most at risk of having chronic sinusitis. Treatment for this condition depends on the underlying cause. Chronic sinusitis symptoms are usually the same as acute sinusitis, which usually occurs due to the common cold. Some of these symptoms include:

• Pain and pressure above the eyes, sides of the nose and the cheeks
• Pain in the throat
• Mucus draining from the nose
• Fever
• Feeling congested
• Frequent sneezing

Doctors used to think that if acute sinusitis went untreated, it would become chronic. Today, they are not so sure if this is still the case.

Understanding the Complications of a Serious Sinus Infection

These situations are very rare, but some people have experienced health complications associated with a serious sinus infection. Some of these complications have involved sinus infections spreading to the eyes and even the brain. Infection spreading to the eyes is the most common complication. This could cause redness, swelling, and even blindness in a severe state called cavernous sinus thrombosis. Sinus infections can also spread to the rear center of one's head causing life-threatening ailments such as brain abscess. When this happens, it is best to see your doctor immediately for additional treatment options. Some of these options include:

Ready To See a Doctor About Your Sinus Infection?

Being aware of complications associated with a sinus infection, symptoms of chronic sinusitis, and identifying the type of infection you have are vital to knowing the serious signs of a sinus infection. If you've been experiencing an infection that will not let up, please contact one of our ENT Doctors by phone or via their website to make an appointment.

TVH ENT Surgeons

How long after starting antibiotics for sinus infection will I feel better?

Do sinus infections feel worse before they get better?

Do antibiotics break up sinus infection?

Is it normal to feel worse before antibiotics Feel better?