Are Antibiotics Recommended For My Cold or Sinus Infection?

Some of the most common visits in primary care are for symptoms related to upper respiratory infections. Patients frequently come to the office with a constellation of symptoms including runny nose, congestion, cough, sneezing, and/or sore throat. So what requires an antibiotic and what does not?

According to the

Infectious Disease Society of America, 90-98% of sinus infections are caused by a virus, and will not respond to antibiotics. It is interesting to note though that sinus infections are the fifth most common reason antibiotics are prescribed.

With a sinus infection, symptoms differ from the common cold with a presence of purulent (pus) nasal drainage, facial pain lasting 3 or 4 days or what feels like upper tooth pain, fevers higher than 102 for more than 2-3 days, and symptoms that seem to improve but then worsen again. This set of symptoms should be evaluated by your primary care provider.

Time is also often a factor; even sinus infections may clear on their own without the need of antibiotics. I sometimes get asked something along the lines of: “If I can get rid of this quicker with an antibiotic, then why not take one?”

Studies have shown that sinus infections with purulent drainage less than 10 days and upper respiratory infections less than 7 days showed no improvement in clearing symptoms faster than with no treatment at all, according to the American Academy of Family Physicians. This means that people would have improved in 7-10 days anyway — not because of the antibiotics. Also, with overprescribing antibiotics when they are truly not needed, we are creating antibiotic resistance. Over time, the antibiotics could stop working.

When someone is sick and miserable with either of these illnesses, what kind of symptom relief can they use while waiting for their immune system to work?

  • Sterile saline nasal irrigation or nasal spray
  • Nasal spray decongestants and oral decongestants are debatable on how beneficial they may be. In general, short-term use (no more that 2-3 days when symptoms are at their worst) is fine. Beyond that they may actually be counterproductive and cause rebound congestion.
  • Nasal steroid sprays may help symptoms, especially if allergies are also an issue
  • Tylenol or ibuprofen can be used for sinus pain or fever
  • Antihistamines may be used if you have allergies
  • Cool mist humidifier
  • Warm facial compress over the sinuses

As always, individuals with special health considerations should be evaluated and monitored by their primary care provider.


Wollenweber, KaraKara Wollenweber, CNP, is a board-certified family nurse practitioner. Practicing in Perrysburg at ProMedica River Road Family Physicians, she is a primary care provider of patients of all ages.  Her focus with patients is on health promotion, and well care to improve the overall health of all of her patients. A graduate of the University of Toledo, she lives locally with her husband and two children.