Is doxycycline the right antibiotic for your sinus infection?

In this article:

• Understanding sinus infection
• Doxycycline for sinus infection
• How quickly does it work?
• Usage instructions
• Important considerations
• Alternative treatments

In this article

• Understanding sinus infection
• Doxycycline for sinus infection
• How quickly does it work?
• Usage instructions
• Important considerations
• Alternative treatments

If you’ve been prescribed doxycycline for a sinus infection, you might wonder how it works and why your provider chose it over something like amoxicillin. Doxycycline is an antibiotic that stops many types of bacteria from growing and spreading, allowing your immune system to clear the infection.

It belongs to a group of antibiotics called tetracyclines, which also includes tetracycline, minocycline, and tigecycline. Although doxycycline is available as a generic, you may recognize it under brand names such as Vibramycin, Doryx, Acticlate, and Vibra-Tabs. A slightly different form, called doxycycline monohydrate, is sold under the brand names Oracea or Monodox. Beyond sinus infections, doxycycline treats a wide range of conditions, including acne, rosacea, tick-borne diseases such as Rocky Mountain spotted fever, and certain sexually transmitted infections.

While amoxicillin is usually the first-line antibiotic for bacterial sinus infections, doxycycline can be a good alternative for people who can’t take penicillin or when other treatments don’t work. Here’s what you need to know about when it’s used, how it helps, and what to watch for.

Understanding sinus infections: Why they happen

Your sinuses are four pairs of air-filled spaces in your skull connected by tiny passageways. When these passages become blocked and fluid builds up, germs can multiply, leading to a sinus infection (sinusitis). Infections can be caused by viruses, bacteria, or fungi, and the resulting inflammation can make your face feel full or painful.

Common symptoms include:

• Headache
• Runny or stuffy nose
• Post-nasal drip
• Pressure in the face
• Pain in the face, especially in the teeth
• Pain in the ear
• Discolored nasal discharge
• Fever 
• Fatigue
• Coughing
• Bad breath or a bad taste in the mouth

A short-lived case is often referred to as acute sinusitis, whereas experts classify cases that last 12 weeks or more as chronic sinusitis. 

When antibiotics are (or aren’t) needed

Most sinus infections clear up on their own, since viruses are the most common cause. Antibiotics target bacteria, not viruses, so taking them unnecessarily won’t help and may contribute to the development of antibiotic resistance. That includes resistance to tetracycline antibiotics, such as doxycycline, which is becoming a growing concern.

Still, some sinus infections are bacterial and may require treatment. “When we treat a sinus infection, we first look at what’s causing it and how long it’s been going on,” explains Monazzah Sarwar, Pharm.D., clinical assistant professor at the University of Illinois Chicago, Retzky College of Pharmacy. Unfortunately, it’s not easy to distinguish between bacterial and viral sinusitis; even the color of the mucus or the presence of pain isn’t a reliable clue.

One sign that can help: how long your symptoms last. Viral infections typically begin to improve within a week, while bacterial infections may linger or even worsen. “The most recent guidelines favor watching and waiting after symptoms arise for most patients because most sinus infections resolve on their own,” says Jordan Smith, Pharm.D., associate professor of pharmacy clinical studies at High Point University.

When is doxycycline a good choice for sinus infections?

There’s no one-size-fits-all antibiotic for sinus infections. Once a healthcare provider determines that antibiotics are necessary, the first-line treatment is usually amoxicillin, sometimes combined with clavulanate (as in Augmentin) to help overcome bacterial resistance.

If someone is allergic to penicillin, a cephalosporin such as Suprax (cefixime) or cefpodoxime may be prescribed instead, says Alan Oshinsky, MD, a board-certified otolaryngologist at Mercy Medical Center in Baltimore.

RELATED: Can you have a delayed reaction to amoxicillin?

Where does doxycycline come in? “Doxycycline is often given as an alternative when other options don’t make sense for (a) particular patient,” Dr. Smith says. Doxycycline may be prescribed for people who:

• Have a penicillin allergy or a reaction to beta-lactamase inhibitors
• Can’t tolerate other antibiotics due to side effects or resistance concerns
• Need a broader-spectrum option when first-line drugs aren’t suitable

Doxycycline isn’t the first choice for everyone.

• Pregnant people: Tetracycline antibiotics can affect fetal bone and tooth development.
• Breastfeeding mothers: Short-term use may be acceptable, but long-term treatment isn’t advised.
• Children younger than 8: Doxycycline can stain developing teeth and affect bone growth.
• Severe infections: May require antibiotics with broader coverage of organisms or intravenous antibiotics.

Exceptions are sometimes made in life-threatening cases, such as anthrax or Rocky Mountain spotted fever.

How quickly does doxycycline work for a sinus infection?

If you’re dealing with sinus pain and congestion, you’re probably eager for relief. The good news: Many cases of acute sinusitis start to improve on their own within seven to ten days, even without antibiotics.

However, if your healthcare provider suspects a bacterial infection and prescribes doxycycline, you may begin to feel better fairly quickly. “Most patients start to feel improvement within three to five days after starting doxycycline,” Dr. Sarwar says. 

Some people feel better even sooner. “The medication usually starts to work in 48-72 hours, but it is very important to complete the entire course of the medication to make sure the bacteria are eradicated,” says Cherie Bragg, MD, a primary care provider with LCMC Health in New Orleans, Louisiana. 

Everyone’s recovery timeline is different, but if your symptoms don’t start improving after a few days on antibiotics or they worsen, please reach back out to your healthcare provider.

How to take doxycycline for a sinus infection

Taking doxycycline correctly helps it work more effectively and lowers your risk of side effects. Here’s what experts recommend:

1. Take it at the same time each day. Consistency helps maintain a steady level of medication in your body and makes it easier to remember your doses.
2. Swallow with plenty of water. “You must take it not just with a sip or two of water. You have to take it with at least six to twelve ounces of water,” Dr. Oshinsky says. This helps prevent the pill from getting stuck in your throat or causing direct irritation to the esophagus, based on the acidic characteristics of the medication.
3. Stay upright after taking it. Remain sitting or standing for at least 30 minutes after your dose to avoid throat discomfort, Dr. Sarwar recommends.
4. Take it with food if needed, but avoid dairy and supplements. You can take doxycycline with a light meal if it upsets your stomach. However, avoid taking it with milk, yogurt, antacids, or supplements that contain calcium, magnesium, iron, or zinc, since these can interfere with how well your body absorbs the drug.
5. Finish the full course. Even if you start to feel better within a few days, take every prescribed dose. Stopping treatment early can allow bacteria to survive and cause the infection to return, or lead to the development of antibiotic resistance.

Potential side effects and important considerations

As with any medication, it’s important to know the potential side effects of doxycycline before you take it. Doxycycline is generally well-tolerated, according to Dr. Smith. The most common side effects of doxycycline include nausea, vomiting, upset stomach, and diarrhea. 

Other possible side effects include:

• Photosensitivity, or sensitivity to sunlight, can lead to sunburns, rashes, and blisters.
• Yeast infections
• Esophagitis, or irritation of the lining of the esophagus

Rare, but serious side effects are also possible, such as Stevens-Johnson syndrome. 

Let your healthcare provider know if you have any other medical conditions or are taking any other medications before you take doxycycline. It’s known to interact with Soriatane (acitretin), which is used to treat severe skin disorders, such as psoriasis. According to the Mayo Clinic, it may be advisable not to take doxycycline with some other medications unless it’s absolutely necessary. 

RELATED: Can you take doxycycline and amoxicillin together?

Alternative treatments for sinus infections

For most people with acute sinusitis, the best first step isn’t an antibiotic. It’s managing the symptoms while your body fights off the infection. Many cases are caused by viruses, not bacteria, and tend to improve within a week or two.

To help ease discomfort, experts recommend:

• Take pain relievers: Over-the-counter options, such as acetaminophen or ibuprofen, can help reduce facial pain or headaches.
• Stay hydrated: Drinking plenty of fluids helps thin mucus.
• Use a humidifier: Moist air can ease congestion and dryness.
• Try nasal irrigation: Rinsing with saline can clear nasal passages and improve breathing.
• Consider nasal steroid sprays: Over-the-counter steroid sprays can reduce inflammation inside the sinuses.

You can also use topical nasal decongestants, but only for three to four days, cautions the American College of Allergy, Asthma & Immunology (ACAAI). Using them longer can cause rebound congestion. Combination products with decongestants and antihistamines should also be used sparingly.

It can take a while to feel better. “But if the infection improves, then gets worse, or it’s been more than 10 days, it’s time to get checked out,” says Dr. Smith. 

If you develop signs of a bacterial sinus infection, your healthcare provider may prescribe an antibiotic. Most clinicians start with a penicillin or cephalosporin, but doxycycline can be a good option for certain patients, adds Alan Oshinsky, MD, of Mercy Medical Center. In many cases, though, the best medicine is simply time, rest, and patience.