Do Not Start Antibiotics Yet
Based on your symptom timeline of only 2-3 days, you do not meet clinical criteria for bacterial infection and should continue supportive care—antibiotics are not indicated at this time and would cause more harm than benefit. 1
Why Antibiotics Are Not Appropriate Now
Your orange/purulent mucus does not indicate bacterial infection by itself. The color of nasal discharge is caused by inflammatory cells (neutrophils) and is completely normal with viral infections. 1
Clinical Criteria for Bacterial Sinusitis
Antibiotics should only be considered if you meet one of these three specific criteria 1:
- Persistent symptoms: Nasal congestion/discharge or cough lasting >10 days without improvement
- Severe symptoms: High fever >39°C (102.2°F) AND purulent nasal discharge for ≥3 consecutive days
- Double worsening: Initial improvement from a viral cold, then new worsening of symptoms (new fever, increased discharge, worsening cough) after 5-7 days
You've only had symptoms since Wednesday night (2-3 days), so you don't meet any of these criteria yet. 1
What You Should Do Instead
Symptomatic Relief (Evidence-Based)
- Analgesics: Acetaminophen, ibuprofen, or naproxen for congestion discomfort and any facial pressure 1
- Intranasal saline irrigation: Helps clear mucus and reduce congestion 1
- Intranasal corticosteroids: (e.g., fluticasone, mometasone) can reduce inflammation and nasal congestion 1
- First-generation antihistamine/decongestant combination: (e.g., chlorpheniramine + pseudoephedrine) taken at bedtime can help with post-nasal drip and congestion 1
- Short-term topical decongestant: Oxymetazoline nasal spray for 3-5 days maximum (avoid longer use due to rebound congestion) 1
Expected Timeline
Most viral upper respiratory infections resolve within 7-10 days without antibiotics. 1
When to Reconsider Antibiotics
Contact your physician if 1:
- Symptoms persist beyond 10 days without any improvement
- You develop high fever >39°C with purulent discharge lasting ≥3 consecutive days
- You initially improve but then worsen significantly after 5-7 days (new fever, dramatically increased symptoms)
Critical Pitfall to Avoid
The number needed to harm from antibiotics (8 patients) is actually greater than the number needed to treat for benefit (18 patients) in acute rhinosinusitis. 1 This means you're statistically more likely to experience adverse effects (diarrhea, rash, yeast infections, Clostridioides difficile colitis) than to gain any benefit at this early stage. 1
Antibiotics do not treat viral infections and will not speed your recovery. 2, 3 Taking them prematurely only increases antibiotic resistance and exposes you to unnecessary side effects. 1