For many people, a sinus infection usually starts as a viral upper respiratory infection that improves on its own over time. The common cold is a textbook example of how this occurs.

Because sinus infections  can cause facial pressure, congestion, and thick nasal drainage, people often assume they need antibiotics to recover. However, the CDC reports that 90% to 98% of sinus infections are caused by viruses, meaning antibiotics won’t help. In fact, using antibiotics unnecessarily can cause side effects and contribute to antibiotic resistance.

Most sinus infections are easily treatable at home, but some require evaluation by a healthcare provider. Understanding the differences between bacterial vs. viral sinus infections can help you know which treatment options are best and when to seek medical care.

What is sinusitis?

“Sinusitis” is the medical term for sinus infections  and general inflammation of the sinus tissue. Viral sinus infections are very common during cold and allergy seasons and usually resolve within 5 to 7 days.

Here are the most common symptoms of sinusitis:

• Facial pressure or pain around the cheeks, eyes, or forehead
• Headaches caused by sinus pressure
• Thick or discolored nasal drainage, including postnasal drip
• Stuffy nose
• Upper jaw or tooth pain from a sinus infection
• Fever
• Cough
• Fatigue or overall tiredness
• Bad breath
• Sore throat

Chronic sinusitis refers to inflammation that lasts for an extended period of time or keeps coming back. It sometimes results from structural issues in the sinuses, systemic problems, or fungal infections.

Why some people are more prone to sinus infections

Some people are more prone to sinus infections  than others, and the frequency with which they occur varies from person to person.

Chronic nasal inflammation, as seen in asthma and allergies, makes it more likely that mucus will become stuck in the sinuses. Nasal polyps, a deviated septum, or constricted sinus apertures are all structural abnormalities that may obstruct normal drainage and raise the risk of recurrent infections.

Furthermore, sinus-affecting viruses, bacteria, or fungi can be harder for people with weakened immune systems to fight off effectively. Recognizing these contributing factors can help patients and providers take a more targeted approach to preventing and managing sinus infections.

Bacterial vs. viral sinus infection: The key differences clinicians use

Bacterial and viral sinus infections both share similar symptoms. The length and intensity of symptoms helps to distinguish between them . Viral sinus infections often improve within about a week. A bacterial cause is more likely, on the other hand, when symptoms last 10 days or longer without improvement, when symptoms are severe early on, or when symptoms improve and then get worse again.

Bacterial sinus infection: The most common “telltale” patterns

Even though viral and bacterial sinus infections share many of the same symptoms, bacterial infections tend to be more severe. You may notice worsening facial pressure, thicker congestion, and nasal drainage that is yellow or green in color. However, discolored drainage doesn’t always mean a bacterial infection. This is another reason that doctors look for patterns and symptom duration to determine the cause.

Doctors often rely on the following pattern-based signs to help distinguish bacterial vs. viral sinusitis and choose the best treatment method:

• Symptoms lasting 10 or more days without improvement, including ongoing congestion or pressure.
• Severe symptoms early on (around days 3–4), such as high fever, significant facial pain or pressure, and extreme fatigue.
• “Double worsening,” where symptoms briefly improve from a cold and then suddenly worsen again with increased pressure, drainage, or a sinus headache.

When do you need antibiotics for a sinus infection?

Getting a correct diagnosis  for a sinus infection is crucial to choosing the right treatment. Viral sinus infections often resolve themselves with over-the-counter pain relievers, water, and rest. Antibiotics are only useful in cases caused by bacterial infections.

Using antibiotics for a viral infection will not help you heal faster and may cause negative side effects, like a rash or allergic reaction. Even worse, it can lead to antibiotic resistance, which can eventually result in difficult-to-treat infections or serious complications. Because of this, unless the symptoms are very severe, a healthcare provider may recommend “watchful waiting” or delaying antibiotic prescriptions for some sinus infections.

If your symptoms last more than 10 days without getting better, get worse after improving, or feel severe, it’s a good idea to see a healthcare provider. Early onset signs of a severe sinus infection may also require evaluation. Antibiotics may be needed when:

• Symptoms are severe and consistent with a bacterial sinus infection.
• Symptoms last longer than 7–10 days without improvement.
• Symptoms worsen after initially starting to get better (“double worsening”).
• A persistent or high fever, for example above 101°F, is present.
• Signs of complications develop, such as swelling around the eyes or severe facial pain.

How to relieve sinus pressure and manage symptoms at home

No matter the type of sinus infection you have, there are multiple at-home remedies  you can use to ease your symptoms. These non-prescription approaches are excellent for managing discomfort while your body heals.

• Decongestants and sinus pain relievers. Reduce nasal swelling while easing facial pressure, headaches, and sinus discomfort. Use only as directed, and check with a healthcare provider before giving over-the-counter cough/cold medicines to children.
• Warm steam inhalation. Loosens mucus and relieves nasal congestion.
• Warm facial compresses. Soothes facial pain caused by sinus pressure.
• Increased fluid intake. Thins mucus to help sinuses drain better.
• Saline nasal spray or nasal rinsing. Flushes thick mucus from the nasal passages.
• Supports the immune system while the body recovers naturally.

Help with viral and bacterial sinus infections

In many cases, all it takes to get over a sinus infection is some rest and at-home remedies. Most people don’t even need to take medicine. Keeping track of your symptoms over time will help you know when you need to visit a doctor. By arming yourself with knowledge, you can safeguard your well-being and ensure you take antibiotics only when necessary.

When you’ve had a sinus infection that lasts more than a few days and/or symptoms that are especially troublesome, it’s a good idea to book an appointment with a physician. The team at Florida Medical Clinic Orlando Health is here to answer any questions you have. We offer personalized care and advanced diagnostic processes to identify the cause of your symptoms. You can rest confidently in our health services, knowing you are receiving expert guidance and treatment.

About Dr. Tran

Dr. David Tran is a warm, approachable family medicine physician who believes the best care starts with truly listening. He values partnership with his patients and works hard to create an environment where everyone feels respected, heard, and comfortable taking an active role in their health.

Dr. Tran completed his medical degree studies at the University of South Carolina School of Medicine and is certified by the American Board of Family Medicine. When he’s not seeing patients, he enjoys running and hiking outdoors, cooking and baking for friends and family, and traveling.

Request an appointment by calling (727) 553-7420.