Do sinus infections always need antibiotics in children (7yr), how to tell if it's bacterial? no fever just runny stuffy nose for a month.

Sinusitis: Only if it is a true sinus infection (bacterial). Many have fluid in their sinuses. It is when the headaches, pain, fever or purulent discharge persist that we treat with antibiotics. First conservative treatments with saline washes, steroid nasal sprays etc. Hope this answers.

Overused meds: With the rates of inappropriate antibiotic use and increasing resistance, I appreciate your question. Fluid culture is ideal, but not practical to confirm the presence of bacteria. Physicians will often combine physical findings, personal history, previous treatment failures and personal experience to make the decision to use antibiotics. Discuss with your physician for a personalized answer.