When Is A Z
Spoiler alert: its not! Because its so easy to use, the Z-Pak used to be a go-to prescription for sinus infections. But it turns out that only a minority of these prescriptions are appropriate because the majority of sinus infections are viral and not bacterial. In fact, studies have found that about a third of antibiotic prescriptions for sinus infections, sore throats, and ear infections arent even necessary. Overprescribing antibiotics increases the chance that bacteria will become resistant to them and disrupt the gut bacterial flora for months. Indeed, azithromycin is no longer recommended for bacterial sinus infections due to the risk of resistance.
If you have a sinus infection, expect to feel lousy for several days. After all, your body is waging war against an infection. You might experience:
A runny nose
A sore throat
Youre also likely to feel more tired and achy and maybe even experience a low-grade fever. Most people improve within a week, but symptoms can last up to 2 weeks. Coughs can linger for a week after that.
Treating a sinus infection boils down to whether its viral or bacterial. Colds, for example, are viral. And antibiotics like the Z-Pak are not effective against viral infections. In fact, viral sinus infections have no cure. Treatment is aimed at managing symptoms and includes:
If you still dont feel better, your healthcare provider may suggest nasal or lung inhalers for other symptoms.
Do You Need Antibiotics For A Sinus Infection
A viral sinus infection will likely resolve itself on its own, but it can take a few weeks to do so. If the sinus infection is caused by bacteria, it is likely to need antibiotics in order to resolve. But antibiotics arent a cure-all. They will not cure a sinus infection that was caused by a virus or an irritant in the air.
Viral Vs Bacterial Sinus Infections
Most sinus infections are caused by viruses that create inflammation in the sinuses, leading to blockage that can make it hard to breathe, nasal secretions, postnasal drip, and other discomfort like facial pain around your eyes, cheeks, nose, or forehead.
Knowing thisand that antibiotics dont work on viral infectionsmost healthcare providers first recommend treatments to relieve the symptoms of a sinus infection while you wait for it to resolve.
These may include:
- Over-the-counter such as pseudoephedrine
- Pain relievers like acetaminophen or ibuprofen to ease discomfort from swelling, fever, or sore throat
In rare cases, viral sinus infections can lead to bacterial growth in the nasal passages.
Theres no way to know for sure if you have a bacterial sinus infection without testing a mucus sample.
But even without a sample, two signs typically indicate a bacterial infection and may prompt your provider to prescribe antibiotics:
- A sinus infection that lasts for more than 10 days
- Symptoms of the infection resolve, then back worse a couple days later
Some people think yellow or green mucus may be a sign of a bacterial sinus infection, but colored mucus can occur with viral infections and does not necessarily mean you have a bacterial infection.
If you do have bacterial sinusitis , it should respond to antibiotics within a few days.
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How Is A Sinus Infection Treated
- Over-the-counter medications: OTC medication like paracetamol or ibuprofen can help relieve symptoms such as pain and fever.
- Nasal decongestant sprays: Nasal sprays like oxymetazoline can reduce swelling and congestion, relieving nasal obstruction. But, they should not be used for too long as long-term use of these sprays can damage the nasal mucosa. Hence, should be used after consulting with a doctor.
- Antibiotics: Antibiotics may be prescribed by a doctor to get rid of the infection faster and prevent complications.
People may be able to treat a sinus infection at home by relieving painful symptoms and taking steps to allow the immune system to fight off the infection.
Risk Of Unnecessary Antibiotics For Sinus Infections
Taking unnecessary antibiotics for a sinus infection is not only ineffectual, but can actually be harmful to the patient. Risks of taking unneeded antibiotics include:
- Increased chance of getting an antibiotic-resistant infection at a later time
- Destruction of healthy stomach bacteria, which can allow harmful bacteria to grow
- Possible side effects, such as upset stomach, rash, or dizziness
- Allergic reaction
According to studies conducted by the American Academy of Allergy, Asthma, and Immunology , 60-70% of patients with sinus infections fully recover without the use of antibiotics. Additional research shows that almost 90% of U.S. adults diagnosed with acute sinusitis are prescribed antibiotics.
This overuse of antibiotics for sinus infections, as well as other conditions, can lead to antibiotic resistance, a state in which bacteria change over time as a reaction to antibiotic treatment, in order to survive and multiply, thus making the antibiotics less effective.
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Treatment For Sinus Infection
Whether you have an acute sinus infection or a chronic infection, a number of treatment options can relieve your discomfort. If youre in the early stage of an acute sinus infection, it may be appropriate to start at-home treatments while you monitor your symptoms. If your sinusitis worsens, youll need to call your doctor for medication and further care. Even if youre receiving treatment from your doctor, at-home care can help ease your symptoms.
When Do I Really Need Antibiotics For A Sinus Infection
When do I really need antibiotics for a sinus infection? is a question many patients have when suffering from bothersome sinus and allergy problems. While sinus infections can be quite painful, antibiotics often do not help in treating the condition.
Sinus infections affect approximately 37 million people in the U.S. each year and can be caused by:
- Nasal polyps or deviated septum causing nasal obstruction
The majority of sinus infections are viral in nature, and antibiotics do not cure viral infections. Taking antibiotics for viral infections also will not:
- Keep you from being contagious to others
- Relieve symptoms or make you feel better
In order to distinguish a bacterial sinus infection from an infection caused by a virus or other contributing factor, your doctor will observe your symptoms and possibly conduct other tests, such as a CT scan or cultures.
Antibiotics are only effective on bacterial infections, and even in cases involving bacteria, the body can often cure itself of mild or moderate infections within a few days.
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About Ear Nose And Throat
Ear, Nose, and Throat Services at UPMC Presbyterian Shadyside ranks among the best nationally on U.S. News & World Reports listings. Our team includes board-certified physicians and highly skilled speech-language pathologists and audiologists. We treat a variety of ear, nose, and throat conditions in both children and adults and provide both surgical and non-surgical options. Our doctors also take part in research and clinical trials. We have locations throughout western Pennsylvania for patient convenience.
Treatments For Sinus Infections Other Than Antibiotics
#1: Saline Nasal Wash
Saline nasal wash can be a great way to thin out the mucous in the sinuses enough to clear out the blockage. I recommend starting this early on in the course of the illness to prevent the infection from worsening.
You can even make this at home using 2 cups of water and a 1/2 teaspoon of salt. I would add a 1/2 to 1 teaspoon of baking soda to prevent burning that can occur with use. There are also plenty of over the counter saline nasal sprays that you can purchase. You can use this 4-6 times per day.
Vaporizers are great because they can also thin out the mucous and make you feel a lot better. An easy home remedy, steam is probably the best way to use this treatment. Beware if you are an asthmatic as the steam could cause worsening of the asthma symptoms.
#3: Steroid Nasal Spray
Steroid nasal sprays such as Flonase have been my go to remedy recently and the great news is that they are now over the counter. The general recommendation is to use 1-2 sprays per nostril daily.
But I have found great relief using 2 sprays in each nostril twice daily. At these higher doses it is important to remember that you should use this short term, no more than 5-7 days.
These medications can significantly reduce inflammation allowing the congestion blockage to clear and significantly alleviate symptoms.
Guaifenesin such as Mucinex can certainly break up the mucous, allowing the congestion to clear more quickly.
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Grapefruit Seed Extract For Treating Digestive Issues
Grapefruit seed extract can help treating H. pylori infection. Helicobacter Pylori is bacteria that may aggressively attack the lining of the stomach. Some of the symptoms of H. pylori infection are stomach ulcers, pain, and general digestive upset. There are other proven natural remedies that can help treat Helicobacter Pylori infection.
Grapefruit seed extract can help to protect your stomach from damage caused by stress and alcohol consumption.
A study found that grapefruit seed extract was effective in treating intestinal infections caused by Candida, Geotrichum sp and hemolytic E. Coli. The participants in the study who received the GSE had a definite improvement in digestive issues such as constipation, flatulence, and abdominal discomfort.
There are no exact guidelines on how much GSE you need to use in order to improve your digestive health. However in the last study I mentioned, participants consumed 2 drops of grapefruit seed extract mixed with 200 mL water twice daily for one month.
Symptoms > 1 Week Are Not A Reason To Prescribe
One very important new finding in this meta-analysis that should change practice is that the duration of illness did not predict a positive response to antibiotics.
Current national recommendations are to use an antibiotic for patients with a duration of illness longer than 1 week, as these patients are presumably more likely to have a bacterial infection.- However, that recommendation had been based on expert opinion, not on data from clinical trials. A longer duration of symptoms should not be a reason to prescribe an antibiotic for sinusitis symptoms.
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Sinus Infection Treatment Timeline With Antibiotics
Our sinuses are hard to reach, so it can be two to three days before antibiotic treatment begins to take effect.
It is critical to continue the whole course of antibiotics, even if you start to feel better. If you dont finish the whole course, your body could begin to build a resistance to those antibiotics. This makes future treatment more difficult.
Sometimes, patients experience negative side effects while taking antibiotics. If you experience rash, hives or have difficulty breathing while taking antibiotics, call your doctor immediately. You may be experiencing an allergic reaction. In older adults, some types of antibiotics may cause inflammation in tendons.
In addition to clearing your sinuses of infection, antibiotics also work in other parts of your body, particularly the gut. This could cause diarrhea, so you may want to take a probiotic as well.
Ways To Recognize Serious Signs Of Sinus Infections
The length of the infection is an important determinant of the seriousness of the infection.
I usually consider most infections less than 3 weeks to be viral or inflammation related to congestion. At this point, the best treatment is usually medications that decrease the congestion and inflammation. This in turn will alleviate the symptoms and ultimately cure the illness.
When the illness continues beyond 3 weeks, bacterial infection can begin to develop. Though antibiotics can be considered at this point, other treatments may still be the best answer if they have not yet been given a try.
#2: Mucous Color
I will dispel a myth right here and now. Yellowish/greenish mucous does not necessarily mean the infection is bacterial.
Viruses can cause the same color mucous. The reason for the mucous is generally not the actual bacteria or virus, but the bodys immune response to the intruder.
So dont worry just because you see a colored mucous when you blow your nose. This will also improve as the infection abates.
#3: Sinus Pain
Sinus pain can occur anytime throughout a sinus infection. This is normal and means there is inflammation in the sinuses, as we discussed previously.
However, severe pain, redness over the skin, hardened skin over the sinuses, or even a severe headache are not generally normal and can indicate a bacterial infection.
A fever can be caused by both viruses and bacteria. So how do you differentiate between the two?
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How To Treat Sinusitis
With symptoms that linger, it can be hard to treat and get rid of a sinus infection for good.
Antibiotics are the standard treatment for combating sinus infections. Taken anywhere from 3 to 28 days, antibiotics help fight the bacteria. Because antibiotics dont typically alleviate symptoms, nasal decongestants, antihistamines, topical nasal corticosteroids and nasal saline can help to manage them.
What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take antibiotics for sinusitis
Reasons not to take antibiotics
I know I have a bacterial infection that is causing my sinusitis.
A virus is causing my sinusitis.
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Challenges To Implementation: The Patient Who Wants A Pill
Some patients may be accustomed to receiving an antibiotic prescription for their sinus infections and may resist conservative management. It may be difficult to convince them that antibiotics wont make a difference when they attribute past resolution of symptoms to antibiotics.
Take enough time to educate your patients on the natural course of illness, the positive benefits of nasal saline, and the reasons not to use unnecessary antibiotics this effort will save you time in future visits. A just in case you dont get better prescription to be filled only if the patient is not improving in the next few days is about 50% effective in reducing antibiotic usage for upper respiratory infections.
Should You Take An Antibiotic For Sinus Infections
Today, the medical community knows that prescribing antibiotics for sinus infections isnt always the right route to go. In fact, the American Academy of Allergy, Asthma & Immunology cites that about 60 to 70 percent of people with sinus infections can get better without any antibiotics at all. However, not everyone is listening. WebMD reports that bout 90 percent of adults seen in the U.S. by a general practice physician do end up getting an antibiotic for acute sinusitis.
How many of us have gone to the doctor and heard, You have a sinus infection Ill give you an antibiotic to be on the safe side. The truth is that unless the symptoms have lasted more than 10 days or have disappeared and come back within a few days, your infection is most likely viral. And unfortunately, antibiotics wont help a virus.
But the real issue associated with taking an antibiotic when it isnt necessary goes beyond it being ineffective: its antibiotic resistance. The Centers for Disease Control and Prevention states that at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.
Antibiotic resistance occurs when bacteria become so used to a particular medication that they mutate and are no longer affected by the same drug. This new resistant strain then multiplies and continues to cause harm until a new antibiotic is developed to treat it. And then the circle begins again.
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But Sometimes Antibiotics For Sinus Infections Are Needed
So how does one judge when it is appropriate to prescribe antibiotics for a sinus infection? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if its been less than 10 days, they meet criteria for antibiotic treatment.
The authors, however, also suggest that doctors discuss watchful waiting with patients and explain that most sinus infections clear up on their own in one to two weeks, and its a safe option to hold off on antibiotics. The symptoms can then be treated with a cocktail of over-the-counter medications and supportive care, like nasal saline irrigation, nasal steroid sprays, decongestants, and pain medications.
Of course, many patients expect and demand antibiotics for sinus infections, and even those who are open to watchful waiting may hear about the rare but possible complications of things like, oh, brain abscess, and opt to treat.
In the case of my patient above, she met criteria for treatment. She weighed the watchful waiting option against the potential risks of antibiotics for her sinus infection, and chose the prescription. I can tell you from very close follow-up that she improved quickly, though in truth, we will never really know if she would have gotten better anyway.
Two Types Of Sinus Infections
Lets differentiate between acute and chronic sinus infections. Acute sinus infections can last up to 4 weeks. If you are experiencing sinus infection symptoms for longer than 2 weeks, it doesnt mean you have a bad case of sinusitis this is normal. If you experience symptoms for longer than 4 weeks, this can be considered subacute anything that lasts longer than 12 weeks is considered chronic.
Now, lets differentiate between bacteria and viruses. Either of the two can infect the body, and each warrants a different course of treatment. Bacterial infections require antibiotics, while viral infections do not they resolve themselves. All you can do in the latter case is to drink plenty of fluids, rest, and take decongestants. The majority of cases are viral, in which case your doctor cant prescribe you with anything other than decongestants.
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