Table of ContentsView AllTable of ContentsUse in Sinus InfectionsWhat Is Azithromycin?Special ConsiderationsSafe TreatmentFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Use in Sinus Infections

What Is Azithromycin?

Special Considerations

Safe Treatment

Frequently Asked Questions

Healthcare providers prescribeazithromycinfor treating certain bacterial infections, such as pneumonia. However, azithromycin does not effectively eliminate all types of bacteria and is not recommended for treating sinus infections.

A healthcare provider can help determine whether azithromycin is an appropriate treatment choice.

This article contains information about azithromycin and why it may not be effective for treating sinus infections.

Azithromycin for Sinus Infections

The results suggest that about 70% of the time, sinus infections will resolve on their own within two weeks without treatment.

The evidence also shows that taking antibiotics for sinus infections can cause side effects more often than not, highlighting the potential risk of using antibiotics for sinus infections.

Antibiotic Resistance

The use of azithromycin for sinus infections raises a major concern:antibiotic resistance, in which bacteria develop ways to reduce or evade the effects of antibiotics. As resistance grows, bacteria become harder to treat or, in some cases, impossible to treat. Resistant bacteria can cause the infection to continue spreading and even lead to life-threatening illness.

The length of azithromycin treatment for certain bacterial sinus infections is three days, according to the Food and Drug Administration (FDA) drug label.In the limited situations where azithromycin might be effective for a sinus infection, it is often overprescribed in terms of length of treatment. This further increases the risk of bacterial resistance.

In a study of azithromycin use, Centers for Disease Control and Prevention (CDC) researchers found that many people were prescribed the drug for up to 14 days. This extended dosing increases the risk of developing azithromycin-resistant bacteria.

Experts do not recommend using aZ-pakto treat sinus infections since the six tablets in a convenient Z-pak are for use over five days,which is two days longer than advised. This longer-term treatment, therefore, raises the risk of side effects and antibiotic resistance.

Older male uses pharmacy mobile app to refill prescription.SDI Productions / Getty Images

Older male uses pharmacy mobile app to refill prescription

SDI Productions / Getty Images

Azithromycin is a generic macrolide antibiotic used to treat a variety of mild to moderate infections. It comes in tablets and a liquid suspension for oral use, as well as inintravenous(IV) injection and eye drop forms.

The FDA approves a more limited set of azithromycin uses in children. These include:

The approved uses of azithromycin also vary with the specific form prescribed. For instance, only the AzaSite eye drop is approved for treatingbacterial conjunctivitis (pink eye)in adults and children ages 1 year and older.

How Does Azithromycin Work?

Antibiotics are generally grouped based on how they work:bactericidalorbacteriostatic.

“Bactericidal” means the antibiotic kills the bacteria, while “bacteriostatic” means it stops the bacteria from growing. Macrolides, including azithromycin, are bacteriostatic.

Azithromycin’s mechanism of action (how it works) is the same as other macrolide antibiotics. Specifically, azithromycin binds to a protein known as 23S, which is responsible for helping bacteria grow and reproduce.

When azithromycin binds to this protein, it halts the DNA processes necessary for growth and spread. Without this protein’s help, the bacteria cannot reproduce and grow, which stops the infection.

Taking azithromycin may result in some mild side effects. Common side effects associated with azithromycin use include:

In rare instances, azithromycin causes more severe side effects, such as:

How to Safely Treat Sinus Infections

While the majority of sinus infections go away on their own within two weeks, nonprescription medications are available to help manage the symptoms. Here are some options available to you for relief:

Acute vs. Chronic Sinusitis

Sinus infections, or sinusitis, can be acute (short term) or chronic (long term). Acute sinusitis lasts less than four weeks, whilechronic sinusitispersists for over 12 weeks.

Acute and chronic sinus infection symptoms are typically similar: runny nose, excess mucus, stuffy nose, and pain or pressure in the face or head. Fever can also occur with the onset of a sinus infection and usually lasts for a few days.

Most sinus infections resolve independently, but lingering infections may require a visit with a healthcare provider.

Summary

Azithromycin is a relatively safe and effective treatment option for many infections. However, experts advise against using azithromycin or Z-pack for sinus infections. This is because azithromycin isn’t effective against viruses, which are the most common cause of sinus infections.

Furthermore, taking azithromycin unnecessarily or for too long can promote antibiotic resistance. To relieve symptoms, it’s best to try over-the-counter medications, self-care, and nondrug options like warm compresses.

If symptoms don’t go away, consult a healthcare provider for advice.

Frequently Asked QuestionsAntibiotics work to eliminate harmful bacteria in the body, but they can also kill off the “good” bacteria that normally live in the body. The good bacteria, or normal flora, help prevent “bad” bacteria from overgrowing. Overusing antibiotics kills more good bacteria and allows antibiotic-resistant bacteria to multiply quickly without competition.If your healthcare provider prescribes an antibiotic for a sinus infection, it will likely be a short course of treatment, typically three to seven days. The medication begins working quickly, but it may take the full course of treatment before your symptoms improve. If more than a week passes without improvements, talk to your provider, as the antibiotic may not be working.Even if you begin to feel better midway through your course of antibiotics, do not stop taking it. Stopping antibiotics early may cause the infection to return and become more difficult to treat.Sinus surgery is a potential treatment option for those with frequent recurrent or chronic sinus infections, especially for individuals whose primary symptom is facial pain or nasal blockage. This minimally invasive procedure can help restore normal function to the sinus cavities and reduce the likelihood of future infections.

Antibiotics work to eliminate harmful bacteria in the body, but they can also kill off the “good” bacteria that normally live in the body. The good bacteria, or normal flora, help prevent “bad” bacteria from overgrowing. Overusing antibiotics kills more good bacteria and allows antibiotic-resistant bacteria to multiply quickly without competition.

If your healthcare provider prescribes an antibiotic for a sinus infection, it will likely be a short course of treatment, typically three to seven days. The medication begins working quickly, but it may take the full course of treatment before your symptoms improve. If more than a week passes without improvements, talk to your provider, as the antibiotic may not be working.Even if you begin to feel better midway through your course of antibiotics, do not stop taking it. Stopping antibiotics early may cause the infection to return and become more difficult to treat.

If your healthcare provider prescribes an antibiotic for a sinus infection, it will likely be a short course of treatment, typically three to seven days. The medication begins working quickly, but it may take the full course of treatment before your symptoms improve. If more than a week passes without improvements, talk to your provider, as the antibiotic may not be working.

Even if you begin to feel better midway through your course of antibiotics, do not stop taking it. Stopping antibiotics early may cause the infection to return and become more difficult to treat.

Sinus surgery is a potential treatment option for those with frequent recurrent or chronic sinus infections, especially for individuals whose primary symptom is facial pain or nasal blockage. This minimally invasive procedure can help restore normal function to the sinus cavities and reduce the likelihood of future infections.

18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluation.Food and Drug Administration.Zithromax (azithromycin) package label.Lemiengre MB, van Driel ML, Merenstein D, et al.Antibiotics for acute rhinosinusitis in adults.Cochrane Database Syst Rev.2018; 9:60-89. doi:10.1002/14651858.CD006089.pub5.Centers for Disease Control and Prevention.Antimicrobial resistance.Chow AW, Benninger MS, Brook I, et al.IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.Clin Infect Dis.2012;54(8):72-112. doi:10.1093/cid/cis370.King LM, Sanchez GV, Bartoces M, et al.Antibiotic therapy duration in US adults with sinusitis.JAMA Intern Med.2018;178(7):992-994. doi:10.1001/jamainternmed.2018.0407.DailyMed.AzaSite label.Fernandez-Obregon, AC.Azithromycin for the treatment of acne.Int Jour Dermatol.2001;39(1):45-50. doi:10/1046/j.1365-4362.2000.00749.x.Oshikoya KA, Wharton GT, Avant D, et al.Serious adverse events associated with off-label use of azithromycin or fentanyl in children in intensive care units: A retrospective chart review.Paediatr Drugs. 2019;21(1):47-58. doi:10.1007/s40272-018-0318-9Uzun S, Djamin RS, Kluytmans JA, et al.Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial.Lancet Respir Med. 2014;2(5):361-368. doi:10.1016/S2213-2600(14)70019-0Zalmanovici Trestioreanu A, Yaphe J.Intranasal steroids for acute sinusitis.Cochrane Database Syst Rev. 2013;2013(12):CD005149. doi:10.1002/14651858.CD005149.pub4DailyMed.Sudafed Sinus 12 Hour label.DailyMed.Levofloxacin tablet label.Food and Drug Administration.Augmentin (amoxicillin and clavulanate potassium) tablet label.Centers for Disease Control and Prevention.Sinus infection.Cho SH, Ledford D, Lockey, RF.Medical management strategies in acute and chronic rhinosinusitis.J Allergy Clin Immunol Pract.2020;8(5):1559-1564. doi:10.1016/j.jaip.2020.02.020.Brook I.Microbiology of sinusitis.Proc Am Thorac Soc.2011;8(1):90-100. doi: 10.1513/pats.201006-038RN.Slack R & Bates G, et al.Functional endoscopic sinus surgery.Am Fam Physician.1998;58(3):707-718.

18 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluation.Food and Drug Administration.Zithromax (azithromycin) package label.Lemiengre MB, van Driel ML, Merenstein D, et al.Antibiotics for acute rhinosinusitis in adults.Cochrane Database Syst Rev.2018; 9:60-89. doi:10.1002/14651858.CD006089.pub5.Centers for Disease Control and Prevention.Antimicrobial resistance.Chow AW, Benninger MS, Brook I, et al.IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.Clin Infect Dis.2012;54(8):72-112. doi:10.1093/cid/cis370.King LM, Sanchez GV, Bartoces M, et al.Antibiotic therapy duration in US adults with sinusitis.JAMA Intern Med.2018;178(7):992-994. doi:10.1001/jamainternmed.2018.0407.DailyMed.AzaSite label.Fernandez-Obregon, AC.Azithromycin for the treatment of acne.Int Jour Dermatol.2001;39(1):45-50. doi:10/1046/j.1365-4362.2000.00749.x.Oshikoya KA, Wharton GT, Avant D, et al.Serious adverse events associated with off-label use of azithromycin or fentanyl in children in intensive care units: A retrospective chart review.Paediatr Drugs. 2019;21(1):47-58. doi:10.1007/s40272-018-0318-9Uzun S, Djamin RS, Kluytmans JA, et al.Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial.Lancet Respir Med. 2014;2(5):361-368. doi:10.1016/S2213-2600(14)70019-0Zalmanovici Trestioreanu A, Yaphe J.Intranasal steroids for acute sinusitis.Cochrane Database Syst Rev. 2013;2013(12):CD005149. doi:10.1002/14651858.CD005149.pub4DailyMed.Sudafed Sinus 12 Hour label.DailyMed.Levofloxacin tablet label.Food and Drug Administration.Augmentin (amoxicillin and clavulanate potassium) tablet label.Centers for Disease Control and Prevention.Sinus infection.Cho SH, Ledford D, Lockey, RF.Medical management strategies in acute and chronic rhinosinusitis.J Allergy Clin Immunol Pract.2020;8(5):1559-1564. doi:10.1016/j.jaip.2020.02.020.Brook I.Microbiology of sinusitis.Proc Am Thorac Soc.2011;8(1):90-100. doi: 10.1513/pats.201006-038RN.Slack R & Bates G, et al.Functional endoscopic sinus surgery.Am Fam Physician.1998;58(3):707-718.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluation.Food and Drug Administration.Zithromax (azithromycin) package label.Lemiengre MB, van Driel ML, Merenstein D, et al.Antibiotics for acute rhinosinusitis in adults.Cochrane Database Syst Rev.2018; 9:60-89. doi:10.1002/14651858.CD006089.pub5.Centers for Disease Control and Prevention.Antimicrobial resistance.Chow AW, Benninger MS, Brook I, et al.IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.Clin Infect Dis.2012;54(8):72-112. doi:10.1093/cid/cis370.King LM, Sanchez GV, Bartoces M, et al.Antibiotic therapy duration in US adults with sinusitis.JAMA Intern Med.2018;178(7):992-994. doi:10.1001/jamainternmed.2018.0407.DailyMed.AzaSite label.Fernandez-Obregon, AC.Azithromycin for the treatment of acne.Int Jour Dermatol.2001;39(1):45-50. doi:10/1046/j.1365-4362.2000.00749.x.Oshikoya KA, Wharton GT, Avant D, et al.Serious adverse events associated with off-label use of azithromycin or fentanyl in children in intensive care units: A retrospective chart review.Paediatr Drugs. 2019;21(1):47-58. doi:10.1007/s40272-018-0318-9Uzun S, Djamin RS, Kluytmans JA, et al.Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial.Lancet Respir Med. 2014;2(5):361-368. doi:10.1016/S2213-2600(14)70019-0Zalmanovici Trestioreanu A, Yaphe J.Intranasal steroids for acute sinusitis.Cochrane Database Syst Rev. 2013;2013(12):CD005149. doi:10.1002/14651858.CD005149.pub4DailyMed.Sudafed Sinus 12 Hour label.DailyMed.Levofloxacin tablet label.Food and Drug Administration.Augmentin (amoxicillin and clavulanate potassium) tablet label.Centers for Disease Control and Prevention.Sinus infection.Cho SH, Ledford D, Lockey, RF.Medical management strategies in acute and chronic rhinosinusitis.J Allergy Clin Immunol Pract.2020;8(5):1559-1564. doi:10.1016/j.jaip.2020.02.020.Brook I.Microbiology of sinusitis.Proc Am Thorac Soc.2011;8(1):90-100. doi: 10.1513/pats.201006-038RN.Slack R & Bates G, et al.Functional endoscopic sinus surgery.Am Fam Physician.1998;58(3):707-718.

Food and Drug Administration.Orange book: approved drug products with therapeutic equivalence evaluation.

Food and Drug Administration.Zithromax (azithromycin) package label.

Lemiengre MB, van Driel ML, Merenstein D, et al.Antibiotics for acute rhinosinusitis in adults.Cochrane Database Syst Rev.2018; 9:60-89. doi:10.1002/14651858.CD006089.pub5.

Centers for Disease Control and Prevention.Antimicrobial resistance.

Chow AW, Benninger MS, Brook I, et al.IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.Clin Infect Dis.2012;54(8):72-112. doi:10.1093/cid/cis370.

King LM, Sanchez GV, Bartoces M, et al.Antibiotic therapy duration in US adults with sinusitis.JAMA Intern Med.2018;178(7):992-994. doi:10.1001/jamainternmed.2018.0407.

DailyMed.AzaSite label.

Fernandez-Obregon, AC.Azithromycin for the treatment of acne.Int Jour Dermatol.2001;39(1):45-50. doi:10/1046/j.1365-4362.2000.00749.x.

Oshikoya KA, Wharton GT, Avant D, et al.Serious adverse events associated with off-label use of azithromycin or fentanyl in children in intensive care units: A retrospective chart review.Paediatr Drugs. 2019;21(1):47-58. doi:10.1007/s40272-018-0318-9

Uzun S, Djamin RS, Kluytmans JA, et al.Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial.Lancet Respir Med. 2014;2(5):361-368. doi:10.1016/S2213-2600(14)70019-0

Zalmanovici Trestioreanu A, Yaphe J.Intranasal steroids for acute sinusitis.Cochrane Database Syst Rev. 2013;2013(12):CD005149. doi:10.1002/14651858.CD005149.pub4

DailyMed.Sudafed Sinus 12 Hour label.

DailyMed.Levofloxacin tablet label.

Food and Drug Administration.Augmentin (amoxicillin and clavulanate potassium) tablet label.

Centers for Disease Control and Prevention.Sinus infection.

Cho SH, Ledford D, Lockey, RF.Medical management strategies in acute and chronic rhinosinusitis.J Allergy Clin Immunol Pract.2020;8(5):1559-1564. doi:10.1016/j.jaip.2020.02.020.

Brook I.Microbiology of sinusitis.Proc Am Thorac Soc.2011;8(1):90-100. doi: 10.1513/pats.201006-038RN.

Slack R & Bates G, et al.Functional endoscopic sinus surgery.Am Fam Physician.1998;58(3):707-718.

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