Treating Acute Bacterial Rhinosinusitis (ABRS)
How Long Will It Take before I Feel Better?
Most patients with acute bacterial rhinosinusitis (ABRS) feel better within seven days, and by 15 days, about 90% are cured or improved.
Is There Anything I Can Do for Symptomatic Relief?
There are several ways to relieve sinusitis symptoms that should be discussed with your doctor to decide which are best for you:
- Acetaminophen or ibuprofen can relieve pain and fever.
- Saline irrigations, or washing out the nose with salt water, can relieve symptoms and remove mucus that is hard to blow out.
- Nasal steroid sprays can reduce symptoms after 15 days of use, but the benefit is small (about 14 people must use them to get one person better), and side effects include headache, nasal itching, and nosebleeds.
Decongestants may help you breathe easier and can be taken as a nasal spray (for no more than three days in a row to avoid worsening congestion) or by mouth.
Is There Anything I Should Not Do?
Antihistamines and oral steroid medicines should not be used routinely because they have side effects and do not relieve symptoms.
If I Have ABRS, Do I Have to Take an Antibiotic?
No, watchful waiting is the preferred way to treat ABRS if you have had symptoms for less than two weeks at the time of diagnosis. Most people get better naturally, and antibiotics only slightly increase symptom relief (about 10 to 15 people must use antibiotics to get one more person better after seven to 15 days).
Is There Any Downside to Using Antibiotic?
Antibiotics have side effects that include rash, upset stomach, nausea, vomiting, allergic reactions, and causing resistant germs.
How Is Watchful Waiting Done?
Your healthcare provider will give you information about how to ease your symptoms and provide a plan to follow up with you. They may also give you an antibiotic prescription, but you should only fill the prescription if you do not get better after three to five days or if you get worse at any time. If you do use the antibiotic, contact your doctor’s office and let them know.
If I Use an Antibiotic, for How Many Days Should I Take It?
Antibiotics are often given for seven to 10 days to treat ABRS, but shorter courses may be equally effective with fewer side effects. Ask your doctor about a five- to seven-day course of antibiotics.
Source
Clinical Practice Guideline: Adult Sinusitis Update. Otolaryngology–Head and Neck Surgery 173, no. 5 (2025): S1-S56. https://doi.org/10.1002/ohn.1344
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