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Do I need an antibiotic with a greater than ten day history of sinus pressure of that is not resolving, or is worsening symptoms after 5-6 days?
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Antibiotics should be used expeditiously for sinusitis. For symptoms that are not resolving after 10 days, or getting worse after 5-6 days, antibiotic is warranted. Typically amoxicillin, or amoxicillin/clavulanate as first line treatment, with doxycycline in penicillin resistant patients. It is far cheaper to visit a primary care doctor ($100) than an urgent care ($200) or ER ($2000) for antibiotics for a sinus infection that needs antibiotics.
Am Fam Physician. 2006 Sep 15;74(6):956-966.; Gonzales R, et al. Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults: Background, Specific Aims and Methods. Ann Intern Med. 2001;134:479-86, Best Practices in the Management of Patients with Acute Bronchitis/Cough 2016-2017; The Sinus and Allergy Health Partnership. Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis. Otolaryngol Head Neck Surg. January, Supplement 2004;130:1-45.; Chow AW, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012;54(8): e72-e112.; Snow V, et al. Principles of Appropriate Antibiotic Use for Acute Sinusitis in Adults: Background. Ann Intern Med. 2001;134:498-505.; Slavin RG, et al. The Diagnosis and Management of Sinusitis: A Practice Parameter Update. J Allergy Clin Immunol. 2005;116:S13-47.