Duration Health

Nose and Sinus


Congestion of the nose is very common and is usually caused by the viruses that cause “the common cold” or seasonal allergies. This congestion often spreads to the sinuses, leading to a feeling of mild pressure in the nose and face, and a mild headache.

Sometimes the congestion can continue for too long and can lead to bacterial growth in the sinuses, which can lead to an infection called bacterial sinusitis. This presents with severe congestion with pus coming from the nose, facial pain or pressure that is worst on the sides of the nose or the forehead, fevers, and headaches. This infection requires antibiotic treatment because if left untreated, it can spread deeper into the face, into the facial bones and even spread to the brain, which is a life-threatening medical emergency that necessitates immediate care.


For nasal congestion and sinus pressure, you can try oxymetazoline (generic for Afrin®) nasal spray to relieve the congestion, ibuprofen to relieve pain and inflammation, or nasal saline to help clear the mucus. Bacterial sinusitis may be treated with an antibiotic called amoxicillin-clavulanate.

Most "sinus infections" do NOT need antibiotics. Millions of people suffer side effects every year, including uncontrollable diarrhea, after taking antibiotics for sinus symptoms when one is not necessary. It is highly recommended to try ibuprofen first and wait to see if your symptoms resolve, before considering antibiotics.

When To Worry

Seek immediate medical care if you have any of the following:

Quick Guide

If you have

  • nasal congestion < 10 days
  • mild cough
  • mild sore throat
  • mild facial pressure
  • no fever

You may have

viral upper respiratory infection or seasonal allergies

Consider using

ibuprofen 600 mg every 6 hours as needed for pain OR

acetaminophen 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

oxymetazoline nasal spray (generic for Afrin®) 2 sprays in each nostril every 12 hours for not more than 3 days

fluticasone propionate nasal spray (generic for Flonase®) 2 sprays in each nostril once daily

If you have

  • fever 100.4°F or higher
  • facial pain
  • persistent nasal congestion (>10 days)
  • nasal drainage with pus

You may have

bacterial sinusitis

Consider using

amoxicillin-clavulanate 875 mg-125mg twice daily for 7 days


doxycycline 100 mg by mouth twice daily for 7 days

and seek emergency medical care

Most "sinus infections" do NOT require antibiotics. See the Infection section.

If amoxicillin-clavulanate is unavailable or if an allergy to penicillins is present, either doxycycline OR azithromycin may be considered as an alternative, although they may be less effective.

If you have

  • persistent fever that does not improve with medication
  • vision changes
  • hearing changes
  • eye bulging or swelling around the eyes
  • severe headache
  • paralysis of the facial muscles

You may have

an abscess or meningitis

You should

seek emergency medical care


Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.


Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.


Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.


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