Sinusitis: How to Tell If It’s Just a Cold or Something Worse

Most sinus problems start like a common cold. Stuffy nose, pressure around your cheeks or eyes, and a thick nasal discharge are normal early on. If those symptoms stay mild and begin to improve in a week, it's probably viral and will clear on its own. But if pain gets worse, fever spikes, or symptoms hang on past 10 days, that's when you should pay attention.

When antibiotics are needed

Antibiotics only help when bacteria cause the infection. Doctors look for signs like high fever, severe face pain, symptoms that worsen after initial improvement (a "double sickening" pattern), or symptoms lasting longer than about 10 days. First-line antibiotics often include amoxicillin-clavulanate. If you’re allergic to penicillin, doctors may choose alternatives such as doxycycline or trimethoprim-sulfamethoxazole (Bactrim) depending on your history.

A quick note: azithromycin (Zithromax) used to be popular, but resistance makes it less reliable in many places. If you want more on antibiotic options, check our guides: "Best Safe Alternatives to Amoxicillin," "Zithromax: Uses, Side Effects," and "Top Alternatives to Vibramycin."

Practical home care you can do today

Start with things that actually help relief: nasal saline rinses (neti pot or squeeze bottle), nasal steroid sprays for congestion, warm compresses for pain, and over-the-counter pain relievers like acetaminophen or ibuprofen. Stay hydrated, rest, and use a humidifier if your air is dry. Decongestant pills or sprays can ease symptoms short-term, but avoid nasal sprays for more than a few days—rebound congestion is real.

If you have chronic sinusitis (symptoms lasting 12 weeks or more), treatment shifts. Your doctor will look for underlying causes like nasal polyps, allergies, or structural issues. In those cases, longer steroid courses, allergy control, or even ENT referral for imaging and possible surgery may be needed.

Watch for red flags: high fever, severe swelling or redness around the eyes, worsening vision, severe headache with neck stiffness, or confusion. Those require immediate medical attention.

Preventing repeat sinus trouble is often simple: control allergies, don’t smoke, wash hands, stay hydrated, and get flu and COVID vaccines. Humidify your home in dry months and treat chronic allergic rhinitis if it’s a trigger.

If you’re unsure whether antibiotics are needed, call your healthcare provider. Self-medicating with leftover antibiotics or buying pills online without a diagnosis is risky. For practical reading, see our posts on amoxicillin alternatives, Bactrim, and safe antibiotic choices to help you talk with your doctor.

Got a stubborn case or questions about meds? Reach out to your clinician—sinusitis is common, but the right approach depends on the details of your symptoms and health history.