Sinus Infection Medicine: OTC and Prescription Options Compared

When a sinus infection strikes, the first question most people ask is: what medicine should I take? The answer depends on whether your infection is viral or bacterial, how long it has lasted, and how severe your symptoms are. Reaching for the wrong treatment can delay recovery, waste money, and — in the case of unnecessary antibiotics — contribute to antibiotic resistance.

This guide walks you through every major category of sinus infection medicine, from over-the-counter options you can buy today to prescription treatments that require a doctor’s evaluation.

Viral vs. Bacterial Sinus Infection: Why It Matters for Treatment

The single most important thing to understand about sinus infection medicine is this: most sinus infections are viral, and antibiotics do not work against viruses.

According to the American Academy of Otolaryngology, up to 98 percent of acute sinus infections begin as viral infections following a common cold. Only about 2 percent are bacterial from the start, and only a subset of initially viral infections develop a secondary bacterial component.

How to tell the difference:

• Viral sinusitis: Symptoms peak around days 3–5 and gradually improve by days 7–10. Nasal discharge may be clear or slightly colored. Treatment focuses on symptom relief while the body clears the virus.
• Bacterial sinusitis: Symptoms last 10+ days without improvement, worsen after initial improvement (called “double sickening”), or include high fever (above 102°F / 38.9°C) with thick, colored discharge and severe facial pain. Antibiotics may be appropriate.

This distinction is crucial because it determines your entire treatment approach.

Over-the-Counter Medicines for Sinus Infections

1. Pain Relievers and Anti-Inflammatories

What they do: Reduce the facial pain, headache, and inflammation that accompany sinus infections.

Best options:

• Ibuprofen (Advil, Motrin): Both pain relief and anti-inflammatory action make it the top OTC choice for sinus infections. It directly reduces the mucosal swelling that traps mucus. Typical dose: 200–400 mg every 4–6 hours as needed.
• Naproxen (Aleve): Similar anti-inflammatory benefits but longer-lasting (up to 12 hours per dose). Good for sustained daytime relief. Typical dose: 220 mg every 8–12 hours.
• Acetaminophen (Tylenol): Effective for pain and fever but no anti-inflammatory effect. Choose this if you cannot take NSAIDs (e.g., due to stomach issues, kidney disease, or blood-thinning medications). Typical dose: 500–1000 mg every 4–6 hours.

Tip: Ibuprofen or naproxen is generally preferred over acetaminophen for sinus infections specifically because the anti-inflammatory action addresses the root cause (mucosal swelling), not just the pain.

2. Nasal Decongestant Sprays

What they do: Oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) constrict blood vessels in the nasal tissue, rapidly shrinking swollen membranes and opening blocked sinus drainage pathways.

Pros: Fastest-acting congestion relief available — works within 1–3 minutes. Can provide dramatic improvement in sinus drainage.

Critical limitation: Must be limited to 3 consecutive days. Using decongestant sprays beyond 3 days causes rebound congestion (rhinitis medicamentosa) — a condition where the nasal tissue swells worse than before, creating a dependency cycle.

Best strategy: Use for the first 2–3 days of severe blockage, then switch to saline spray and other methods for ongoing relief.

3. Oral Decongestants

What they do: Pseudoephedrine (Sudafed) and phenylephrine constrict blood vessels systemically, reducing nasal and sinus swelling from the inside.

Pros: No rebound congestion risk. Can be used for longer than nasal sprays. Pseudoephedrine is more effective than oral phenylephrine (studies have questioned whether oral phenylephrine works better than placebo).

Cons: Can raise blood pressure and heart rate. Not suitable for people with hypertension, heart disease, thyroid disorders, or anxiety. May cause insomnia, jitteriness, or dry mouth. Pseudoephedrine requires showing ID at the pharmacy (behind-the-counter in the US).

4. Nasal Steroid Sprays

What they do: Fluticasone (Flonase), triamcinolone (Nasacort), and budesonide (Rhinocort) reduce inflammation in the nasal and sinus tissue over time.

Pros: Address the underlying inflammation rather than just symptoms. No rebound risk. Effective for both viral and allergic sinusitis. Can be used daily for weeks or months.

Cons: Take 1–3 days to reach full effect — not ideal for immediate relief. May cause nosebleeds and nasal dryness in some users.

Best strategy: Start using a nasal steroid spray as soon as sinus infection symptoms begin. It builds effectiveness over the first few days and provides sustained anti-inflammatory action throughout the infection. Use alongside faster-acting treatments (decongestants, saline) for immediate comfort.

5. Saline Nasal Spray and Irrigation

What they do: Saline moisturizes nasal tissue, thins mucus, flushes irritants and bacteria, and supports the body’s natural clearance mechanisms.

Pros: Zero side effects, no interaction with other medications, unlimited use, safe for all ages. Every major medical guideline recommends saline as a core sinus infection treatment.

For sinus infections specifically, full nasal irrigation with a neti pot or squeeze bottle is significantly more effective than spray alone because it delivers a much larger volume of saline that can reach the sinus openings.

6. Antihistamines

What they do: Block histamine, reducing allergic inflammation that can trigger or worsen sinusitis.

When they help: If your sinus infection was triggered by allergies, antihistamines (cetirizine, loratadine, fexofenadine) can reduce the allergic component. Azelastine nasal spray provides faster local relief.

When they do not help: For purely viral or bacterial sinusitis without an allergic component, antihistamines are not useful — and first-generation types (diphenhydramine/Benadryl) can actually thicken mucus, making drainage harder.

7. Expectorants

What they do: Guaifenesin (Mucinex) thins mucus throughout the respiratory system, making it easier to drain from the sinuses and cough up from the chest.

Pros: Can help when thick mucus is the primary problem. Works for both sinus and chest congestion.

Cons: Effectiveness varies between individuals. Must be taken with plenty of water to work properly.

Prescription Medicines for Sinus Infections

Antibiotics

When they are appropriate: Only for confirmed or strongly suspected bacterial sinusitis — symptoms lasting 10+ days without improvement, double sickening, or high fever with severe facial pain.

First-line antibiotic: Amoxicillin or amoxicillin-clavulanate (Augmentin) is the recommended first choice. Treatment duration is typically 5–10 days.

For penicillin allergy: Doxycycline or a respiratory fluoroquinolone (levofloxacin) may be prescribed.

Important: Taking antibiotics for viral sinusitis does not help and contributes to antibiotic resistance. The American Academy of Otolaryngology recommends watchful waiting for the first 7–10 days of acute sinusitis unless symptoms are severe.

Prescription Nasal Steroid Sprays

Higher-potency versions of OTC steroid sprays may be prescribed for severe or chronic sinusitis. These include mometasone (Nasonex) and ciclesonide (Omnaris).

Oral Corticosteroids

Short courses of oral prednisone (3–7 days) may be prescribed for severe sinus inflammation, particularly when nasal polyps are present. Oral steroids provide powerful anti-inflammatory action but carry more side effects than nasal sprays and are reserved for significant cases.

Natural and Complementary Treatments

Several natural approaches can complement OTC and prescription medications:

• Herbal tea: Anti-inflammatory teas like ginger, turmeric, eucalyptus, and peppermint provide hydration, decongestant steam, and natural anti-inflammatory compounds.
• Steam inhalation: 10-minute steam sessions 2–3 times daily help open sinus drainage pathways.
• Warm compresses: Applied to the face for 5–10 minutes, warm compresses promote sinus drainage and soothe facial pain.
• Sinus pressure techniques: Acupressure, facial massage, and other targeted sinus pressure relief methods can provide immediate comfort from facial pain.
• Hydration: At least 8–10 glasses of water daily to keep mucus thin and support immune function.

Treatment Timeline: What to Take When

Days 1–3 (Early Symptoms)

• Saline irrigation 1–2 times daily
• Start nasal steroid spray (it takes days to build up)
• Ibuprofen for pain and inflammation
• Herbal tea and steam inhalation for comfort
• Nasal decongestant spray if severely blocked (start the 3-day clock)

Days 4–7 (Peak Symptoms)

• Continue saline irrigation and steroid spray
• Stop nasal decongestant spray (switch to saline only)
• Add guaifenesin if mucus is very thick
• Continue pain relief as needed
• Monitor for improvement — most viral infections start improving by day 7

Days 8–10+ (Decision Point)

• If improving: Continue supportive treatment. Full recovery from viral sinusitis can take up to 2 weeks.
• If not improving or worsening: See a doctor. Bacterial sinusitis may be present and antibiotics may be appropriate.

When to See a Doctor

Seek medical evaluation if:

• Symptoms last 10+ days without any improvement
• Symptoms worsen after initially improving (double sickening)
• Fever exceeds 102°F (38.9°C)
• Severe facial pain, especially one-sided
• Swelling or redness around the eyes or forehead
• Vision changes or severe headache
• More than 4 sinus infections per year (may indicate chronic sinusitis needing specialist referral)

Bottom Line

The best sinus infection medicine strategy combines multiple treatments targeting different aspects of the infection. Saline irrigation is the essential foundation — recommended by every major guideline. Nasal steroid sprays address underlying inflammation. Ibuprofen manages pain while reducing swelling. And decongestant sprays or oral decongestants provide fast relief for severe blockage (limited to 3 days for sprays).

Most importantly, give your body time. The majority of sinus infections are viral and resolve on their own within 7–10 days with supportive care. Reserve antibiotics for cases that meet the criteria for bacterial infection, and you will recover just as fast while preserving antibiotic effectiveness for when it is truly needed.