---
title: Most Sinus Infections Don't Need Antibiotics, but 77.8% of Primary Care Clinicians in a Claims Analysis Overprescribed Them
description: Most sinus infections are viral and clear up without antibiotics, yet 77.8% of US primary care clinicians overprescribed them. What helps instead.
author: Dr Marina Nani (Editor-in-Chief)
date: 2026-10-28T10:12:34.359Z
updated: 2026-10-28T10:12:34.385Z
canonical: https://richhealthmagazine.com/article/do-you-need-antibiotics-for-a-sinus-infection
image: https://cdn.nanimediahouse.com/pexels-medical-professional-in-scrubs-consulting-with-a-patient-whi-8413157.jpg
categories: Everyday Wellness
content_type: News
region: United States
publication: Rich Health Magazine
schema_type: Article
---

Most sinus infections clear up without antibiotics, yet more than three-quarters of the 22,178 primary care clinicians whose 2023 and 2024 insurance claims Motive Medical Intelligence reviewed kept prescribing them. Motive, the healthcare data company whose claims analysis showed that [doctors have almost stopped prescribing opioid cough syrup to children](https://richhealthmagazine.com/article/opioid-cough-syrup-children-nearly-vanished), covered clinicians in all 50 states and Washington, DC. It says 77.8% of them overprescribed antibiotics to patients with acute sinusitis, looking only at sinus infections that had lasted less than 10 days. Its state overuse rates ran from 70.4% in Minnesota and 71.3% in Louisiana, the only two states to meet what Motive calls its 72% best-practice benchmark, to 83.8% in South Dakota, 83.7% in Utah and 83.6% in Washington.

About one in eight US adults report having sinusitis each year, according to the American Academy of Otolaryngology-Head and Neck Surgery Foundation, and doctors make more than 30 million sinusitis diagnoses a year.

## Viruses Cause About 98 Percent of Short Sinus Infections

The American Academy of Otolaryngology-Head and Neck Surgery estimates that [about 98 percent of acute sinusitis cases are caused by a virus](https://www.enthealth.org/conditions/sinusitis/), not bacteria, and says those cases should not be treated with antibiotics. The CDC tells patients that "when antibiotics aren't needed, they won't help you, and their side effects could still cause harm." Those side effects run from a rash to severe allergic reactions and C. diff, an infection that causes diarrhea and can lead to severe colon damage and death.

The American College of Physicians and the CDC both recommend that clinicians "reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days."

## Rinses, Steroid Sprays and Pain Relievers Ease Symptoms While Most Sinus Infections Clear on Their Own

ENT Health, the academy's patient site, defines acute sinusitis as symptoms lasting less than four weeks, and lists pain relievers such as acetaminophen or ibuprofen, steroid nasal sprays and salt water rinses through the nose for a viral sinus infection. The CDC adds a warm compress over the nose and forehead, a decongestant or saline nasal spray, and breathing in steam from a bowl of hot water or a shower.

"Patients don't need to leave empty-handed, and doctors don't need to fear patient dissatisfaction," said Dr Rich Klasco, Motive's chief medical officer. "Saline rinses, nasal steroids, and a clear plan for when to come back are the right choice for most sinus infections."

The CDC says to see a healthcare provider if you have severe symptoms such as a severe headache or facial pain, symptoms that get worse after starting to improve, symptoms that last more than 10 days without getting better, a fever that lasts longer than three to four days, or several sinus infections in the past year.

## Fear of Missing an Infection Keeps Doctors Prescribing

Klasco called prescribing an antibiotic for acute sinusitis "a particularly frustrating example of low-value care, as the evidence has been known for years." Doctors fear missing a serious infection, a concern systematic reviews have found to be largely unfounded, Motive says. The American College of Physicians and the CDC add that many patients expect more from antibiotics than the drugs can do for sinusitis, and many physicians worry that their patient satisfaction scores will fall if they say no.

Motive says unnecessary antibiotics for acute sinusitis make up nearly 20% of all outpatient antibiotic prescriptions in the US and cost the healthcare system more than $11 billion a year.

## FAQ

**Q: Is a sinus infection viral or bacterial?**
A short sinus infection is almost always viral: ENT Health puts the bacterial share of acute cases at about 2 percent. Sinusitis that lasts 12 weeks or more is a different condition, chronic sinusitis, which ENT Health says is caused more by inflammation than infection and is treated mainly with salt water rinses and steroid nasal sprays.

**Q: How can you tell if a sinus infection is bacterial?**
ENT Health describes acute bacterial sinusitis as an infection that does not improve at all within 10 days of getting sick, or one that gets worse within 10 days after you had started to feel better. It suggests asking your doctor directly whether you have a bacterial infection, and says X-rays or CT scans of the sinuses are not necessary to diagnose uncomplicated sinusitis.

**Q: When should you see a doctor for a sinus infection?**
Beyond the warning signs above: if you see a doctor sooner, the CDC says they may suggest watchful waiting, which means waiting two to three days to see whether you need antibiotics, or delayed prescribing, where they write a prescription but ask you to hold off two to three days before filling it.

**Q: Do you need antibiotics for a sinus infection?**
For most short sinus infections, no. Even a bacterial infection does not automatically need them: the academy's clinical guideline says "clinicians should offer watchful waiting (without antibiotics) for adults with uncomplicated" acute bacterial sinusitis, as long as follow-up is assured. ENT Health adds that pain relievers, steroid nasal sprays and salt water rinses are also good options for bacterial cases.