Most sinus infections are viral and get better on their own — antibiotics only help the minority that are bacterial (typically symptoms lasting 10+ days without improvement, or that worsen after initial improvement). Watchful waiting is a reasonable first step.
What guidelines recommend to try first. Tap one we rate for its independent monograph.
Amoxicillin (with or without clavulanate)
First-line per CDC/AAFP when a bacterial sinus infection is treated; amoxicillin-clavulanate is preferred when broader coverage is wanted.
The IDSA-preferred agent for acute bacterial rhinosinusitis.
An alternative for penicillin allergy.
Respiratory fluoroquinolone (levofloxacin)
An alternative for penicillin allergy (moxifloxacin is also used).
Azithromycin and other macrolides are NOT recommended for sinus infections because of high pneumococcal resistance (~40%). And most sinusitis needs no antibiotic at all.
CDC — Antibiotic Prescribing and Use: Outpatient Clinical Care for Adults ↗
General reference, not medical advice. Antibiotics are prescription-only; the right one depends on the specific infection, local resistance, your allergies, and your clinician’s judgment. Don’t self-treat, and never use leftover antibiotics or someone else’s — that drives resistance and can be dangerous. See a licensed clinician.