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Can acute sinusitis be treated with antibiotics?

Last Update: October 8, 2014; Next update: 2015.

Antibiotics are only rarely helpful in treating acute sinusitis because it is normally caused by viruses, not bacteria. In a severe infection, however, antibiotics are necessary.

Sinusitis is a condition that many people get more than once in their lives. It mainly affects people during the colder months of the year. Sinusitis can be very painful and also cause other annoying symptoms. It usually lasts for a few days, but sometimes it does not go away for weeks.

Sinusitis is often brought on by a cold. Colds are usually caused by respiratory viruses, and only rarely by bacteria. But bacteria can collect after a viral infection as well. Viruses or bacteria trigger an inflammation, which causes the mucous membranes to swell up. This may keep fluid from draining from the sinuses. If that happens, the fluid becomes thicker and the sinuses fill up with viscous, often yellow-green mucus.

Sinusitis can be treated with pain-relieving and anti-inflammatory drugs, steroid sprays, decongestants and inhalation. Antibiotics are also commonly prescribed.

Research on sinusitis treatment with antibiotics

Researchers from the Cochrane Collaboration international research network wanted to know how effective antibiotics are in the treatment of an inflammation in the maxillary sinuses (the most common form of sinusitis) in adults.

The Cochrane researchers found 63 randomized controlled trials, most of which compared different types of antibiotics. Nine of the studies, involving a total of about 1,900 people, compared antibiotics with fake (placebo) drugs. If symptoms did not improve within one or two weeks at the latest, the researchers considered the treatment to be ineffective.

Odds of improvement only slightly greater after two weeks

The Cochrane analysis of the research on antibiotic treatment shows that maxillary sinusitis usually clears up on its own without these drugs:

  • Without antibiotics, symptoms improved within the first two weeks in 86 out of 100 people.
  • With antibiotics, the number increased to 91 out of 100 people.

This means that an extra 5 out of 100 participants got better more quickly by taking antibiotics.

In the studies that compared different antibiotics with each other, none of them was found to be better than the others.

Antibiotics seemed to cause stomach and bowel problems and skin rashes in some participants. The numbers varied between the studies from 2 to 23 out of 100 people. Only in exceptional cases did participants stop taking the drugs because of side effects.

Because other treatments for sinusitis are available, and since it usually clears up without antibiotics, too, the use of antibiotics for treating sinusitis is often called into question. If you have acute sinusitis, you can first wait for one to two weeks and then see a doctor if the symptoms do not improve. You and your doctor can then decide together whether you need to take antibiotics.

Plus, the overuse and inappropriate use of antibiotics can lead to an increase in bacteria resistant to antibiotics. This means that antibiotics will not always work and that some illnesses can no longer be effectively treated.

Antibiotics are needed if there is a risk of complications

The researchers' conclusions from the studies only apply to mild to moderate forms of sinusitis. People with very severe symptoms were not included in the studies. In their case, a quick treatment with antibiotics is often necessary, because very bad symptoms may be signs of a severe bacterial infection, which can increase the risk of complications. Signs of a serious form of sinusitis include high fever, swelling around the eyes, inflamed and red skin, severe facial pain, sensitivity to light and a stiff neck.


  • Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H et al. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2014; (2). CD000243. [PubMed: 24515610]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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