When Do You Really Need Antibiotics For That Sinus Infection
- By Monique Tello, MD, MPH, Contributor
It was February, and clinic was teeming with respiratory infections of all kinds: mostly the common cold, but also bronchitis, pneumonia, and sinus infections. The patients were coming in usually thinking that they needed antibiotics for their sinus infection, or another respiratory infection.The first patient on my schedule was a healthcare provider with sinus infection written down as her main issue.* Shed had about two weeks of nasal and sinus congestion which she blamed on a viral upper respiratory infection . Her two young kids had been sick with colds all winter, so she wasnt surprised to have these symptoms, along with endless postnasal drip and a cough.
Her congestion had improved a bit at one point, and she thought that she was finally getting better. But then, the day before her appointment, she awoke with throbbing pain between her eyes, completely blocked nasal passages, and, more concerning to her, green pus oozing from her left tear duct. She had body aches, chills, and extreme fatigue. Do I maybe need antibiotics? she asked.
What Causes A Sinus Infection
Sinus infections are often the side effect of a virus such as a cold or the flu. These viruses are mainly spread via tiny droplets of air that come from coughing, sneezing, or blowing your nose. Sinus infections may also be caused by allergies or irritants such as cigarette smoke or nasal sprays. Occasionally, sinus infections may be caused by bacteria.
Using The Right Water During Saline Rinses
When using saline nasal rinses, tap water should always be boiled and then allowed to cool to ensure cleanliness distilled water or premixed solutions could also be used instead of regular tap water.
Other home remedies for sinus infections include:
- Drinking fluids: Drinking lots of fluids helps loosen and thin mucus. Avoid beverages that are caffeinated and alcoholic beverages that can dehydrate the body, which could thicken mucus.
- Breathing steam: Warm water is best . You can breathe in steam from either a bowl or shower.
- Humidifying the air: Use a cool air vaporizer or humidifier,particularly at night while sleeping.
- Avoiding environmental substances: Avoid tobacco smoke and chlorinated water that can dry up the mucus membranes and exacerbate symptoms.
- Implementing treatment measures: At the first sign of infection, use antihistamines and employ regular nasal rinses.
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Research Into Antibiotics And Sinus Infections
The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.
In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.
This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.
Patients who got no treatment were as likely to get better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.
The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.
Sinusitis In The Real World
How effective are antibiotics for patients diagnosed not by sinus x-rays or CTs, but by signs and symptomsas we typically do in daily practice?
A meta-analysis3 of 13 randomized controlled trials found that sinusitis improved without antibiotics, but it included trials in which patients were recruited based on results of imaging studies and cultures, which are not normally used in primary care clinical practice. That study compared antibiotic treatment to placebo for acute uncomplicated sinusitis 35% of placebo-treated patients were clinically cured by 7 to 12 days and 73% were improved after 7 days. Antibiotic therapy increased cure rates by 15% and improvement rates by 14%, yielding a number needed to treat of 7 to achieve 1 additional positive outcome at 7 days.
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What Decongestants And Nasal Sprays Soothe Or Cure Sinus Infections Or Sinusitis
Taking decongestants and mucolytics orally may be helpful in assisting drainage of sinus infection.
The treatment of chronic forms of sinus infection requires longer courses of medications, such as Augmentin, and may require a sinus drainage procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia. In general, antihistamines should be avoided unless it is felt that the sinusitis sinus infection is due to allergies, such as pollens, dander, or other environmental causes.
It is likely that the use of a topical nasal steroid spray will help reduce swelling in the allergic individual without the drying that is caused by using antihistamines although both are occasionally used. Oral steroids may be prescribed to reduce acute inflammation and to help with chronic inflammation in cases with or without polyps and in allergic fungal sinusitis.
In many people, allergic sinusitis develops first, and later, bacterial infection occurs. For these individuals, early treatment of allergic sinusitis may prevent the development of secondary bacterial sinusitis.
In rare instances or in natural disasters, fungal infections may develop in debilitated people. Death rates of 50%-85% have been reported for patients with these sinus infections. Treatment relies on early diagnosis followed by immediate surgical debridement, antifungal drugs, , and stabilizing any underlying health problem such as diabetes.
Do I Need Antibiotics For A Sinus Infection
Sinus infections can be extremely frustrating, especially when you have a headache and facial pain that doesnt go away, coupled with the inability to breathe through your nose. You want immediate relief, but unfortunately, it takes at least a few days to start feeling better. You may think you need to go to the doctor and get antibiotics for a sinus infection, but this isnt always the case.
In the winter months, sinus infections, colds, bronchitis, pneumonia, the flu, and other respiratory infections are common. Patients think that if they come down with an illness, they will require antibiotics. However, most sinus infections dont require antibiotics.
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What Tests Diagnose The Cause Of Sinus Infections And Sinusitis
Sinus infection is most often diagnosed based on the history and examination of a doctor. Because plain X-ray studies of the sinuses may be misleading and procedures such as CT and MRI scans, which are much more sensitive in their ability to diagnose a sinus infection, are so expensive and not available in most doctors’ offices, most sinus infections are initially diagnosed and treated based on clinical findings on examination. These physical findings may include
- redness and swelling of the nasal passages,
- purulent drainage from the nasal passages ,
- tenderness to percussion over the cheeks or forehead region of the sinuses, and
- swelling about the eyes and cheeks.
Occasionally, nasal secretions are examined for secreted cells that may help differentiate between infectious and allergic sinusitis. Infectious sinusitis may show specialized cells of infection while allergic sinusitis may show specialized white blood cells of allergy . Physicians prescribe antibiotics if a bacterial infection is suspected. Antibiotics are not effective against viral infections many physicians then treat the symptoms.
In addition, both rigid and flexible endoscopy has been used to obtain diagnostic material from sinuses. These procedures are usually done by an otolaryngologist under topical and local anesthesia. Occasionally, there may be a need to sedate the patient. Some investigators suggest that endoscopy specimens are comparable to those obtained by needle puncture.
What Happens When Unnecessary Antibiotics Are Prescribed
Research shows that even bacterial infections can clear up on their own without antibiotics within one to two weeks. This means that the majority of the time, antibiotics are unnecessarily prescribed. Of all sinus infections, 85% clear up on their own, while only 15% do not. This 15% is the population that needs antibiotics.
Consuming antibiotics, even when you need them, increases side effects and bacterial resistance rates. This means that the more antibiotics prescribed, the more the bacteria will adapt to become resistant to that specific antibiotic. And there are only so many antibiotics to go around, so resistance should not be taken lightly. Thats why the overprescription of antibiotics is a public health emergency.
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Experts Update Best Practices For Treating The 1 In 8 Us Adults Suffering From Sinusitis
- Sinusitis affects about 1 in 8 adults in the United States, resulting in over 30 million annual diagnoses. The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year.
- More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy.
- Because sinusitis is treated differently based on its cause, it is critical to differentiate between acute viral sinusitis and acute bacterial sinusitis.
- New evidence supports a recommendation of either watchful waiting or antibiotic therapy for mild, moderate, or even severe acute bacterial sinusitis.
ALEXANDRIA, VA An updated clinical practice guideline from the American Academy of OtolaryngologyHead and Neck Surgery Foundation published today in OtolaryngologyHead and Neck Surgery identifies quality improvement opportunities and explicit actionable recommendations for clinicians managing adult sinusitis, including a greater focus on patient education and patient preference.
More than ever before, there is a prominent role for shared decision-making between patients and clinicians when managing adult sinusitisespecially in deciding whether to use antibiotics for acute bacterial sinusitis or to instead try watchful waiting to see if a patient can fight the infection on his or her own.
Richard M. Rosenfeld, MD, MPH
Other differences between the 2007 guideline and the 2015 update include:
What Is A Serious Sinus Infection Like
When sinus infections occur, theyre usually classified as either acute or subacute infections, meaning they go away in one to four weeks and are relatively minor.
The problem is chronic sinus infections, which often wont go away without intervention. If your sinus infection is persisting for longer than a month, and the symptoms are only getting worse, you may be suffering from chronic sinusitis. At that point, the infection is most likely bacterial, and your body will need the help of antibiotics to purge it.
Its very important to consult a healthcare professional before considering antibiotics, not only because youll require a prescription from a licensed doctor but because taking antibiotics more often than needed isnt good for your natural bacteria levels.
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What Is A Sinus Infection
The sinuses are cavities in the head that are filled with air. These air-filled pockets are lined with a very thin layer of mucus that functions to collect particles from the air that are breathed in, such as dust, germs, or other particles.
Very small hair-like projections function to sweep the mucus, along with any particles trapped inside of the mucus. The germ- or dirt-filled mucus then slides down the back of the throat and into the stomach where stomach acid works to kill any germs.
When a sinus infection occurs, this natural process involving mucus flow is blocked.
How Long Do Symptoms Last
Typically, a sinus infection clears up within 2 to 3 weeks. COVID-19 lasts for about a week or two depending on its severity and your overall health.
A 2020 study surveyed 270 outpatients with COVID-19. Among them, 175 people reported returning to their usual level of health about 7 days after a positive COVID-19 test.
Some symptoms like cough and loss of smell or taste may linger temporarily after COVID-19. Some people may experience long-haul COVID-19, a group of symptoms that persist in the weeks and months following an infection.
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Check If You Have Sinusitis
Sinusitis is common after a cold or flu.
Symptoms of sinusitis include:
- bad breath
Signs of sinusitis in young children may also include irritability, difficulty feeding, and breathing through their mouth.
The sinuses are small, empty spaces behind your cheekbones and forehead that connect to the inside of the nose.
Sinusitis causes the lining of the sinuses to swell up.
This stops mucus draining into your nose and throat properly, making you feel blocked up.
What Causes Pressure In Your Sinuses
Sinus pressure is caused by the swelling and inflammation of the membranes inside your sinus passages. This irritation causes the membranes to produce more mucus to try to flush out whatever is causing the inflammation. The excess mucus then adds to the pressure inside the sinus cavities.
Some triggers of sinus pressure include:
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Sudafed For Sinus Infection
Sudafed is a brand name for a powerful decongestant, pseudoephedrine used widely for treating sinus congestion. This works by shrinking the dilated blood vessels in the nose that can cause stuffiness. Some variants of Sudafed are prepared with a combination of ibuprofen that can provide relief from headaches and muscle aches while some other variants are prepared with other nasal congestants that provide more effective relief.
Pathogenesis Of Acute Sinusitis
Acute sinusitis usually follows an acute upper respiratory tract infection . As the viral infection spreads in the nasal mucosa, swelling and oedema of the mucosa results. As the mucosal surfaces of the ostiomeatal unit are in close proximity to one another , obstruction of the sinus ostia results. In addition, the viral infection may reduce normal cilial motility. This prevents normal muco-ciliary clearance resulting in an accumulation of mucus in the sinuses and the development of the symptoms of sinusitis. If this mucus becomes secondarily infected by bacteria, acute bacterial sinusitis develops.
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What Is Sinus Infection
Medically known as rhinosinusitis, Sinus infection or Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection. It occurs when your nasal cavities become infected, swollen, and inflamed. Sinusitis is usually caused by a virus and often persists even after other upper respiratory symptoms are gone. In some cases, bacteria, or rarely fungus, may cause a sinus infection.
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How To Treat A Sinus Infection Without Antibiotics
Before you consider antibiotics, a sinus infection can be treated without leaving at home. Some of the home remedies to treat a sinus infection without antibiotics include:
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When Did You First Start Experiencing Sinus Issues Why Did You Decide To Try Virtuwellcom
I had been experiencing pain, congestion and other issues with my sinuses for well over a week. I had considered going to clinic, but the idea of dragging all of the boys along with me sounded horrible. I remembered my husband used virtuwell.com for his sinus infection last year and within a few days he was feeling better.
While making dinner, I logged onto virtuwell.com. It took me about 10 minutes to answer the questions about my condition and medical historywith at least 5 interruptions from the boys. I got my treatment plan soon after, which told me I had a bacterial sinus infection and a prescription was being sent to our Pharmacy in about an hour.
Some Steps You Can Take
Whether your sinus infection turns out to be viral or bacterial, you can help to ease your symptoms early on with supportive sinus care:
If your symptoms arent improving after one week, its important to see your doctor. If a bacterial infection is suspected, youll probably need to take an antibiotic to clear up the infection and prevent further complications.
If your infections occur more frequently, and your doctor really wants to establish if they are bacterial or viral, your Otolaryngologist or ear, nose and throat doctor can sample the snot from your nose when youre infected and send it to a laboratory to know for sure.
Note: Antibiotics wont help a viral infection, and taking an antibiotic unnecessarily can do more harm than good. You risk possible side effects and increase your chances of developing antibiotic resistance, which can make future infections harder to treat, says Dr. Sindwani. So its important to wait and see how long your symptoms last.
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What Is The Best Medicine For Sinus Pressure
Treating sinus pressure often requires more than one medicine. For example, you may combine a decongestant with a pain reliever to reduce swelling and relieve pain at the same time. Since there are different causes of sinus pressure, the best medicine will vary for each individual.
Most sinus infections are caused by viruses. A prescription-strength nasal steroid spray can help quickly relieve symptoms. If your congestion is a result of a bacterial infection, you may be prescribed antibiotics. One of our doctors can evaluate your symptoms online today and prescribe these medications if you qualify.
If youre experiencing sinus pressure symptoms, book an appointment with one of our physicians and get started with treatment today.