I have had a sore throat and sinus symptoms for nine days; as an otherwise healthy adult without drug allergies, what is the likely diagnosis and recommended management?

Sinus Infection with Sore Throat for 9 Days

You most likely have acute bacterial rhinosinusitis (ABRS) and should start amoxicillin 500mg three times daily for 10-14 days. 1

Why This Is Bacterial Infection

Your 9-day symptom duration crosses the critical threshold that distinguishes bacterial from viral infection:

• Symptoms persisting beyond 7-10 days without improvement strongly suggest bacterial sinusitis rather than a self-limited viral upper respiratory infection 2, 1
• The American Academy of Allergy, Asthma, and Immunology specifically identifies symptom persistence beyond 10 days as the key diagnostic criterion for ABRS 2, 1
• Most viral upper respiratory infections resolve within 7-10 days, so your 9-day course indicates bacterial superinfection 3

Key Symptoms to Confirm Diagnosis

You should have at least two of these three cardinal symptoms to confirm ABRS:

• Purulent (colored/cloudy) nasal drainage - the most predictive symptom 2, 1
• Nasal obstruction or congestion 2
• Facial pain, pressure, or dental pain 2, 1

Your sore throat is likely from postnasal drainage of infected sinus secretions 2

First-Line Treatment

Start amoxicillin immediately - this remains the gold standard first-line antibiotic due to its efficacy, narrow spectrum, safety profile, and cost-effectiveness 2, 1:

• Dosing: 500mg three times daily (or 875mg twice daily) for 10-14 days 2, 1
• Continue treatment until symptom-free for 7 days 1
• The most common bacterial pathogens (Streptococcus pneumoniae and Haemophilus influenzae) remain susceptible to amoxicillin in most cases 2, 4

If No Improvement in 3-5 Days

Switch to high-dose amoxicillin-clavulanate or a second-generation cephalosporin if symptoms don't improve or worsen after 3-5 days of amoxicillin 2, 1:

• High-dose amoxicillin-clavulanate (2000mg/125mg twice daily) covers resistant bacteria and beta-lactamase producers 1, 4
• Alternative: cefuroxime axetil or cefpodoxime 1

Essential Adjunctive Therapy

Add intranasal corticosteroid spray (fluticasone or mometasone) - this significantly improves symptom relief and sinus drainage 2, 1:

• Use twice daily throughout antibiotic course
• Particularly helpful for reducing facial pain and nasal congestion 1

Saline nasal irrigation helps clear purulent secretions and improves antibiotic penetration 1

Supportive Care

• Adequate hydration 5
• Analgesics (acetaminophen or ibuprofen) for pain relief 5
• Warm facial compresses 5
• Sleep with head elevated 5

Critical Pitfall to Avoid

Do not stop antibiotics early even if you feel better - complete the full 10-14 day course to prevent recurrence and development of antibiotic resistance 5. The American Academy of Allergy, Asthma, and Immunology emphasizes that inadequate treatment duration is a common cause of treatment failure 2

When to Seek Urgent Care

Seek immediate medical attention if you develop:

• High fever (>102°F/39°C) 3
• Severe unilateral facial pain 2
• Periorbital swelling or vision changes (suggests orbital cellulitis) 2
• Severe headache or altered mental status (suggests intracranial complications) 5, 3

These severe symptoms present in the first 3-4 days would have warranted immediate antibiotics, but are uncommon at day 9 2

If This Becomes Recurrent

If you experience 3 or more episodes per year, you'll need evaluation for underlying causes such as allergic rhinitis, anatomic obstruction, or immunodeficiency 2, 5