Acute Bacterial Sinusitis: What to Watch For and What to Do

If your nose and face feel stuffed, you have thick yellow-green discharge and a fever, you might be dealing with acute bacterial sinusitis. This is an infection of the sinuses caused by bacteria like Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis. Most sinus symptoms start with a viral cold, but when they last or get worse, bacteria can take over.

How to tell if it’s bacterial

Viral colds improve in about a week. Think bacterial when you notice one of these patterns: symptoms lasting more than 10 days without improvement, a high fever (over 102°F / 39°C) plus facial pain, or a “double-worse” pattern — you feel better then suddenly much worse. Thick discolored nasal discharge alone doesn’t prove it’s bacterial, but paired with the timing above it’s a stronger clue.

Common signs: facial pressure or pain (worse when bending forward), nasal congestion, thick nasal mucus, reduced sense of smell, cough, and sometimes ear pressure or tooth pain. If you have severe headache, swelling around the eyes, neck stiffness, or confusion, seek urgent care — those could be complications.

Treatment basics

Not every case needs antibiotics. Doctors usually try supportive care first for mild cases and watch symptoms for a few days. When antibiotics are needed, amoxicillin-clavulanate is a common first choice because it covers the usual bacteria. If you’re allergic to penicillin, clinicians may use alternatives like doxycycline or other recommended agents depending on your situation. Avoid demanding antibiotics for every sinus problem — overuse leads to resistance and side effects.

Other practical steps you can use right away: nasal saline irrigation to flush mucus, steam or humidifiers to ease congestion, and OTC pain relievers such as acetaminophen or ibuprofen for pain and fever. Nasal steroid sprays can help if you have underlying allergies or prolonged inflammation — use them regularly rather than sporadically. Decongestant sprays should be limited to a few days to avoid rebound congestion.

Most uncomplicated cases improve within 7–14 days with the right mix of care. If symptoms don’t get better, worsen after initial improvement, or you develop signs of a more serious problem (vision changes, swelling around the eye, high fever, severe headache), contact your healthcare provider. Routine imaging or cultures aren’t usually needed unless complications are suspected or recovery stalls.

Simple prevention tips: control allergies, avoid cigarette smoke, wash hands often, and treat colds early with rest and fluids. If you have frequent sinus infections, talk to a clinician about allergy testing, nasal sprays, or referral to an ENT specialist. If anything feels off or severe, check with a professional — better safe than sorry.