Researchers say most sinus infections clear up without antibiotics
of ConsumerAffairsNearly 78% of primary care clinicians prescribed antibiotics for acute sinus infections in cases identified as inconsistent with recommended care, according to a new nationwide study.
Antibiotic overuse varies by state, with the highest rates found in South Dakota, Utah and Washington.
Unnecessary antibiotics can do more harm than good, increasing the risk of side effects, contributing to antibiotic resistance and driving up healthcare costs.
If you've ever visited a doctor complaining of a sinus infection, there's a good chance you left with a prescription for antibiotics. But new research suggests that prescription may not have been necessary.
A nationwide study by healthcare analytics company Motive Medical Intelligence found that 77.8% of primary care clinicians overprescribed antibiotics for acute sinusitis, a common condition that causes nasal congestion, facial pressure and headaches.
The study analyzed insurance claims involving 22,178 primary care clinicians across all 50 states and the District of Columbia. The data covered January 2023 through December 2024.
Researchers found a significant disconnect between established medical guidelines and what happens in doctors' offices.
Most sinus infections are caused by viruses, not bacteria. Since antibiotics only work against bacterial infections, taking them for viral sinusitis provides no benefit.
"Prescribing an antibiotic for acute sinusitis is a particularly frustrating example of low-value care, as the evidence has been known for years," said Dr. Rich Klasco, chief medical officer of Motive Medical Intelligence.
Some states have higher overprescribing rates
Although antibiotic overuse was widespread, the researchers found significant differences among states.
Minnesota had the lowest rate, at 70.4%, followed by Louisiana at 71.3%. Both met the company's 72% performance benchmark.
At the other end of the spectrum, South Dakota recorded an overprescribing rate of 83.8%, followed by Utah at 83.7% and Washington at 83.6%.
The findings suggest that patients' likelihood of receiving unnecessary antibiotics may depend partly on where they receive medical care.
However, even the best-performing states showed substantial opportunities for improvement.
The study measured clinicians' prescribing patterns using insurance claims and the company's clinical appropriateness standards. It did not establish that every individual prescription was unnecessary.
Why doctors keep prescribing antibiotics
Sinusitis is one of the most common reasons Americans seek medical care. About one in eight adults reports having sinusitis annually, and the condition accounts for more than 30 million diagnoses each year.
Despite longstanding recommendations to avoid antibiotics for uncomplicated infections, the practice persists.
Researchers point to several possible explanations.
Some physicians worry about overlooking a serious bacterial infection. Others may believe patients expect to receive medication and will be dissatisfied if they leave without a prescription.
Patients also sometimes assume that antibiotics will help them recover faster, even when the infection is viral.
But according to the Centers for Disease Control and Prevention (CDC), most uncomplicated sinus infections improve without antibiotic treatment.
Medical guidelines generally recommend considering antibiotics when symptoms persist for more than 10 days without improvement, become severe or worsen after initially getting better.
The risks of unnecessary antibiotics
Taking antibiotics when they aren't needed carries risks beyond wasting money.
Antibiotics can cause diarrhea, nausea, allergic reactions and other side effects. In some cases, they can also disrupt beneficial bacteria in the body and increase the risk of serious infections, including Clostridioides difficile, commonly called C. diff.
Unnecessary antibiotic use also contributes to antibiotic resistance, making bacterial infections more difficult to treat over time.
The CDC considers improving antibiotic prescribing an important public health priority. Its 2025 antibiotic stewardship report, published in February 2026, found that unnecessary prescribing remains a concern, particularly for respiratory illnesses.
Motive's report cites estimates that inappropriate antibiotic prescribing for acute sinusitis accounts for nearly 20% of outpatient antibiotic prescriptions and contributes to more than $11 billion in annual U.S. healthcare costs. Those are estimates cited by the company, not costs independently calculated from its new claims analysis.
What consumers should do when they have a sinus infection
The findings don't mean patients should refuse antibiotics whenever a doctor prescribes them. Bacterial sinus infections sometimes require treatment, particularly when symptoms are severe, prolonged or worsening.
But patients can ask whether antibiotics are necessary and whether it would be reasonable to wait.
For uncomplicated sinus infections, physicians may recommend treatments aimed at relieving symptoms while the body's immune system clears the infection.
These can include saline nasal rinses, nasal steroid sprays when appropriate, rest, fluids and over-the-counter pain relievers.
"But patients don't need to leave empty-handed, and doctors don't need to fear patient dissatisfaction," Klasco said. He recommends symptom-relief measures and a clear plan for follow-up.
Patients should seek medical attention for severe symptoms, including significant facial pain, persistent high fever, swelling around the eyes or symptoms that worsen after initially improving.
The researchers say healthcare systems could reduce unnecessary prescriptions by monitoring individual clinicians' prescribing patterns and comparing them with evidence-based treatment guidelines.
For consumers, the message is straightforward: An antibiotic prescription isn't always the best treatment for a sinus infection. Sometimes, allowing the infection to run its course, while managing symptoms and monitoring for complications, is the safer choice.
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Posted: 2026-10-28 10:58:24
