Most sinusitis is viral and needs no antibiotic — but there is plenty that does help.
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Sinusitis is inflammation of the sinuses — the air spaces in the bones around the nose and eyes. It causes facial pain and pressure, a blocked nose and thick discharge.
Three things are worth knowing.
1. Most acute sinusitis is viral, and antibiotics do not help. The useful signal for bacterial infection is not the colour of the discharge — it is "double sickening": getting better, then getting distinctly worse again after five to seven days. That pattern, or symptoms still not improving beyond ten days, is what changes the decision.
2. For symptoms lasting beyond ten days, a high-dose steroid nasal spray is usually more useful than an antibiotic — which surprises people, and is worth explaining rather than leaving as an apparent refusal to treat.
3. Most self-diagnosed "sinus headache" is migraine. This is not a technicality: studies of people convinced they had sinus headaches found the large majority actually met the criteria for migraine. Migraine causes facial pain, nasal congestion and watery eyes, and it responds to entirely different treatment. Years get lost to repeated antibiotics for this.
The one thing not to wait on: swelling or redness around the eye, eye pain, double vision or a change in vision needs to be seen the same day.
Worth checking honestly, because the answer changes the treatment entirely:
Divided by whether nasal polyps are present, which changes the treatment. Underlying allergy, asthma, aspirin sensitivity and, occasionally, immune or cilial problems all contribute.
Invasive fungal sinusitis — uncommon, but rapidly destructive, and it occurs in people who are immunosuppressed or have poorly controlled diabetes. Facial numbness, a black area inside the nose, or rapidly progressive symptoms in someone in those groups needs urgent hospital assessment rather than a prescription.
Sinusitis is diagnosed clinically — from the pattern and the timing — and a video consultation handles that well. Imaging is not needed for acute sinusitis, and X-rays in particular add nothing.
We cannot look inside your nose. Nasendoscopy — a thin camera in clinic — is how polyps and structural problems are identified, and we refer for it.
And anything involving the eye goes to hospital the same day, not to a referral letter. Swelling or redness around the eye, eye pain, double vision or reduced vision can indicate infection spreading into the orbit, which needs intravenous treatment urgently.
Supportive treatment, which genuinely helps:
A high-dose intranasal corticosteroid — not an antibiotic. This has better evidence than antibiotics at this stage, and it treats the actual problem, which is swelling blocking drainage.
Technique determines whether it works: aim outwards towards the ear on that side, not up towards the bridge of your nose; do not sniff hard; and allow two weeks of daily use before judging it.
Usually penicillin-based, or doxycycline in penicillin allergy. A back-up prescription — held and used only if things worsen — is often the sensible option.
Then migraine treatment is the answer, and it works — often dramatically, in someone who has had years of antibiotics. See our migraine page. This is one of the more satisfying diagnostic switches in general practice.
Go to A&E or seek same-day care for:
Seek prompt advice for:
Book an appointment for:
Rinsing clears mucus and allergen, reduces swelling and improves how well a steroid spray works. Use bought sachets, or the correct salt and bicarbonate mix.
Never use untreated tap water. Rare but extremely serious infections have followed. Boiled and cooled, distilled or sterile water only — and rinse the device and let it dry between uses.
If you get "sinus attacks" that come and go with entirely well periods in between, throb rather than ache, or come with nausea or light sensitivity — ask about migraine. A great many people have spent years on repeated antibiotics for a condition that would respond within an hour to the right tablet.
Most sinusitis is viral, lasts two to three weeks, and needs no antibiotic at all. Saline nasal rinses, simple painkillers and some steroid nasal sprays are available over the counter and inexpensive, and they are the treatment. Your NHS GP assesses sinusitis free, and pharmacies now treat acute sinusitis in adults and children over 12 through Pharmacy First without an appointment.
That pharmacy route is free, same-day, and we would point you there first.
Saline rinsing deserves particular mention because it is cheap, genuinely effective, and consistently skipped. A sachet-based rinse costs a few pounds and does more for chronic sinus symptoms than most prescriptions.
Where a consultation is worth paying for is chronic sinusitis — symptoms lasting more than twelve weeks. That is a different problem from a bad cold, it is frequently treated with repeated antibiotic courses that do nothing, and what it usually needs is a prolonged steroid nasal spray used correctly, saline rinsing, and consideration of whether nasal polyps or allergy are driving it.
What needs urgent in-person assessment: swelling or redness around the eye, double vision or reduced vision, severe headache with a stiff neck, confusion, or swelling of the forehead. Those suggest spread beyond the sinus and are emergencies.
NICE NG79, Sinusitis (acute): antimicrobial prescribing, is the governing guideline. It recommends no antibiotic for symptoms lasting under ten days, since most cases are viral and self-limiting, and a back-up prescription thereafter where symptoms are not improving — with high-dose nasal corticosteroid considered for symptoms beyond ten days.
NICE Clinical Knowledge Summary, Sinusitis, covers both acute and chronic presentations and the twelve-week threshold that separates them.
EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) is the international consensus underpinning the management of chronic rhinosinusitis, including the central role of saline irrigation and prolonged intranasal corticosteroids, and the distinction between disease with and without nasal polyps.
ENT UK guidance covers referral criteria and the place of surgery in chronic disease.
NG79 also defines the complications requiring emergency admission — periorbital or orbital cellulitis, intracranial involvement, and frontal bone swelling — which underpin the urgent features above.
No. The colour comes from your own immune cells and is present in ordinary viral infections too. What actually predicts bacterial infection is the pattern: getting better and then distinctly worse again after five to seven days, or symptoms not improving at all beyond ten days.
Because for symptoms lasting beyond ten days, a high-dose steroid nasal spray has better evidence than antibiotics. Sinusitis is a drainage problem caused by swelling, and the spray treats the swelling. It is a considered choice rather than a refusal — though technique matters: aim outwards towards the ear, do not sniff hard, and give it two weeks.
Quite possibly — and it is worth taking seriously. Studies of people convinced they had sinus headache found the large majority met the criteria for migraine. Migraine causes facial pain, blocked nose and watery eyes, which is exactly why it gets misread. Clues: throbbing pain, nausea, sensitivity to light or noise, and attacks with completely well periods in between. It responds to entirely different treatment.
Most improve within two to three weeks, and much of that time you will still feel blocked. Beyond twelve weeks it is chronic sinusitis, which needs long-term nasal steroid treatment and saline irrigation rather than repeated antibiotic courses.
Yes, and it is one of the most effective things you can do — with one absolute rule: never use water straight from the tap. Use boiled and cooled, distilled or sterile water, and let the device dry between uses. Rare but very serious infections have followed tap water rinsing.
Usually because something underneath has not been treated — most often allergic rhinitis, sometimes nasal polyps, a deviated septum, smoking, or uncontrolled asthma. Treating the allergy properly through the year does more to prevent recurrence than any number of antibiotic courses.
Worth considering if the pain is one-sided, in the cheek, with upper tooth pain or a foul taste or smell. Dental infection is a genuine and frequently missed cause of sinusitis, and it will not clear until a dentist deals with the tooth — no matter how many antibiotics are prescribed for the sinus.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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