Z-Pak for Sinus Infection: Is It Necessary? (2024)

Sinus infections are a common problem, affecting millions of people each year. Viruses, bacteria, or fungi can cause them. In most cases, sinus infections will go away within a few weeks, and antibiotics may not be necessary. However, your healthcare provider may prescribe antibiotics if your sinus infection is severe or does not improve with home treatments.

A Z-Pak is a five-day course of azithromycin that has been a common antibiotic for sinus infections. Azithromycin is in the class of antibiotics known as macrolides. It prevents bacteria from multiplying. However, it is not a recommended first-line therapy due to the high rate of antibiotic resistance for macrolides.

This article will discuss when it is necessary to treat your sinus infection with an antibiotic, whether Z-Pak is a good option, and other available antibiotics.

Z-Pak for Sinus Infection: Is It Necessary? (1)

What Is a Z-Pak?

A Z-Pak is a five-day course of azithromycin, which is an antibiotic. It treats various bacterial infections, including sinus infections, pneumonia, and ear infections. Azithromycin is also used to treat sexually transmitted infections (STIs) such as chlamydia and gonorrhea.

Can a Z-Pak Treat a Sinus Infection?

Yes, a Z-Pak can be an effective treatment for bacterial sinus infections. However, it is ineffective against viral sinus infections, which account for most sinus infections. Moreover, a Z-Pak is no longer the recommended go-to antibiotic due to the risk of resistance. Instead, it is more likely to be used as a substitute for penicillin antibiotics when a person has a penicillin allergy.

Viruses cause most sinus infections.Viral sinus infections usually go away within seven to 10 days. However, if your symptoms are severe or do not improve after 10 days, you may have a bacterial sinus infection.

It is crucial to see a healthcare provider to get a diagnosis. Your healthcare provider will be able to determine whether a bacterium or virus is causing your infection.

How Long Will a Z-Pak Take to Work

Most people will start to feel better within a few days of taking a Z-Pak for a sinus infection. However, the infection may take up to a week to completely clear. If you do not start to feel better after a few days of taking a Z-Pak, or if your symptoms get worse, you should see your healthcare provider.

Side Effects of a Z-Pak

Azithromycin is generally well-tolerated, but it can cause some side effects. Some of the most common side effects of azithromycin are :

  • Diarrhea
  • Nausea
  • Vomiting
  • Stomach pain
  • Headache
  • Dizziness

Safety Warning About Z-Pak

The Food and Drug Administration (FDA) warns about the risk of abnormal changes in the electrical activity of the heart and irregular heart rhythm with the use of azithromycin. This is known as QT prolongation. You may be at increased risk if you:

  • Have existing QT interval prolongation
  • Have low blood levels of potassium or magnesium
  • Have a slower-than-normal heart rate
  • Use certain medications designed to treat irregular heart rhythms

What Other Antibiotics Can Treat a Sinus Infection?

Other antibiotics can treat bacterial sinus infections, including:

  • Amoxicillin or amoxicillin-clavulanate: Amoxicillin is often prescribed as a first-line therapy for most adults.
  • Doxycycline: Doxycycline is often reserved for use in people who are allergic to penicillin-type antibiotics.
  • Levofloxacin or moxifloxacin. Fluoroquinolones levofloxacin or moxifloxacin may be used in some cases for people with a penicillin allergy.

Your healthcare provider can prescribe the best antibiotic for you based on your circ*mstances.

When to See a Healthcare Provider

If you think you may have a sinus infection, it is essential to see a healthcare provider to get a diagnosis. Your healthcare provider will be able to determine whether bacteria or a virus is the cause of your infection and will prescribe the appropriate treatment.

You should see a healthcare provider if:

  • Your sinus infection is severe, does not improve with home treatment, or gets worse after improving.
  • Your symptoms last more than 10 days.
  • You have a fever over 101 degrees F or a fever lasting longer than three to four days.
  • You have pain or pressure in your face or forehead.
  • You have difficulty breathing or sleeping.


Although antibiotics may be necessary for a bacterial sinus infection, most infections are viral and will resolve on their own with time. However, you should seek care if your symptoms are severe or last longer than 10 days.

While Z-Pak was once a popular antibiotic remedy, it is no longer recommended as a first-line therapy due to the high rate of bacteria resistant to macrolides in the United States. If you have a bacterial sinus infection, you will most likely be prescribed amoxicillin unless you have a penicillin allergy.

If you have sinus infection symptoms, seeing a healthcare provider for a diagnosis is vital. It is important to take all of your antibiotics even if you start to feel better to prevent recurrence or drug resistance.

Frequently Asked Questions

  • Is a Z-Pak better than amoxicillin for a sinus infection?

    Sinus infections can be effectively treated with a Z-Pak or the amoxicillin antibiotic. What's the most suitable depends on your circ*mstances. Your healthcare provider is best positioned to recommend the most appropriate antibiotic by weighing your symptoms, medical history, and other relevant factors.

    For instance, while amoxicillin is highly effective, individuals allergic to penicillin require a different antibiotic, such as azithromycin, which has also been proven to treat sinus infections effectively.

  • What else can I do to find symptom relief from a sinus infection?

    There are many things you can do to find symptom relief from a sinus infection:

    • Drink plenty of fluids.
    • Use a humidifier or take a hot shower to help loosen mucus.
    • Get plenty of rest.
    • Avoid smoking and secondhand smoke.
    • Use over-the-counter pain relievers, such as ibuprofen or acetaminophen.
    • Use nasal saline sprays or rinses.
    • Use cough drops or lozenges.
  • Will a sinus infection clear up without antibiotics?

    Most sinus infections will clear up on their own. However, some people may need antibiotics to treat a bacterial infection. If you have a severe sinus infection or your symptoms do not improve after a few days, you may need to see a healthcare provider for antibiotics.

    It is important to note that taking antibiotics when they are not necessary can lead to antibiotic resistance. Antibiotic resistance is a serious problem that makes it more challenging to treat future infections.

    If you have a sinus infection, seeing a healthcare provider to get a diagnosis is essential. Your healthcare provider will be able to determine whether you have a bacterial infection and, if so, whether antibiotics are necessary.

The author would like to recognize and thank Leen Alyaseen for contributing to this article.

Z-Pak for Sinus Infection: Is It Necessary? (2024)


Z-Pak for Sinus Infection: Is It Necessary? ›

While Z-Pak was once a popular antibiotic remedy, it is no longer recommended as a first-line therapy due to the high rate of bacteria resistant to macrolides in the United States. 3 If you have a bacterial sinus infection, you will most likely be prescribed amoxicillin unless you have a penicillin allergy.

Do I need a Zpack for sinus infection? ›

In most cases, a Z-Pak is not needed to treat a sinus infection. Because it's so easy to use, the Z-Pak used to be a go-to prescription for sinus infections. But it turns out just a few of these prescriptions are appropriate because most sinus infections are viral and not bacterial.

Do you really need antibiotics for sinus infection? ›

You do not need antibiotics for many sinus infections. Most sinus infections usually get better on their own without antibiotics. When antibiotics aren't needed, they won't help you, and their side effects could still cause harm. Side effects can range from mild reactions, like a rash, to more serious health problems.

Why is azithromycin no longer recommended? ›

Azithromycin, a commonly prescribed antibiotic for common infections since the early 1990s, is becoming less effective because of growing antimicrobial resistance.

When do you need a zpack? ›

Doctors tend to prescribe a Z pack to treat a strong bacterial infection. It is an oral medication that a person can take with or without food, and the dose depends on the severity of the infection. Like most medications, it works on some types of illnesses and does not work on others.

What is the first choice antibiotic for a sinus infection? ›

For most patients, we suggest initial empiric treatment with either amoxicillin or amoxicillin-clavulanate. We treat patients with risk factors for resistance with high-dose amoxicillin-clavulanate.

How do I know if my sinus infection is bacterial or viral? ›

Bacteria can cause sinusitis, or they can infect you after a case of viral sinusitis. If you have a runny nose, stuffy nose and facial pain that don't go away after ten days, you might have bacterial sinusitis. Your symptoms may seem to improve but then return and are worse than the initial symptoms.

Can your body fight a sinus infection without antibiotics? ›

Antibiotics and sinus infections

This may give you the idea that you need antibiotics, but most clear up without them. Antibiotics have no effect on viruses and aren't recommended within the first week of developing a cold. About 70% of sinus infections go away within two weeks without antibiotics.

Is it okay to leave a sinus infection untreated? ›

The sinuses are located close to vital structures such as the eyes, brain, and skull base. If left untreated, an infection can spread to these areas and lead to more severe complications such as orbital cellulitis, meningitis, and brain abscess.

What happens if you do nothing for a sinus infection? ›

A sinus infection that goes on for weeks without treatment can make you miserable and may develop into chronic sinusitis. If your infection is allowed to linger, it could also result in some potentially serious complications. These types of issues are rare, but they do occur.

What is the best antibiotic for sinus infection? ›

Best Antibiotics for Sinusitis

Amoxicillin (Amoxil) or amoxicillin clavulanate (Augmentin) are typically the first recommendations for people not allergic to penicillin. Amoxicillin is a penicillin-like antibiotic used to treat all kinds of infections, including chest, ear, and sinus infections.

What happens if you take azithromycin when you don't need it? ›

Antibiotics such as azithromycin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Why is azithromycin high risk? ›

Also, in vitro, azithromycin shows only lim- ited blockade of the potassium channel hERG. This channel is critically involved in cardio- myocyte repolarization, and if it is blocked or otherwise malfunctioning, the result can be a prolonged QT interval, ventricular arrhyth- mias, and even sudden cardiac death.

Will a zpack help a sinus infection? ›

A Z-Pak is a quick course of the antibiotic azithromycin, which is used to treat bacterial upper respiratory tract infections. It used to be a go-to for sinus infections too. However, doctors now know better, and Z-Paks is no longer recommended for sinus infections.

When does a sinus infection need antibiotics? ›

Your doctor may recommend antibiotics if: You have symptoms of acute sinusitis and you have not started to get better after 10 days, even with home treatment. Your symptoms start to get better within 10 days but then get worse again.

Who should not take a Zpack? ›

liver or kidney problems. heart problems, including irregular heartbeats (arrhythmia) ever had diarrhoea when you have taken antibiotics before. myasthenia gravis – azithromycin can make the symptoms of this muscle-weakening condition worse.

What is the best over the counter medicine for a sinus infection? ›

Sneezing, runny nose, cough, postnasal drip: Try an antihistamine, such as Benadryl (diphenhydramine), Claritin (loratadine), or Zyrtec (cetirizine). Nasal congestion or stuffiness: Nasal corticosteroid sprays, such as Flonase Allergy Relief (fluticasone) can be helpful.

What is the best medicine for sinus drainage in the throat? ›

Over-the-counter decongestants like pseudoephedrine (Sudafed) can help reduce congestion and eliminate postnasal drip. Newer, nondrowsy antihistamines like loratadine-pseudoephedrine (Claritin) can work to get rid of postnasal drip. However, these are more effective after you take them for several days.


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