Tuesday, October 4, 2022

Do You Need An Antibiotic For Sinus Infection

But Sometimes Antibiotics For Sinus Infections Are Needed

Are antibiotics needed for a sinus infection?

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.

When Antibiotics Dont Work

Some patients suffer from recurring sinus infections. If your sinus infection does not improve within five to seven days after you finish the whole course of antibiotics, or if you experience another sinus infection within a few weeks, you may be referred to an Ear, Nose and Throat specialist for treatment.

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.

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Antibiotics And Sinus Infections

When a sinus infection hits, it seems worse than what you remembered from the last time you had one. This may give you the idea that you need antibiotics, but most clear up without them. Antibiotics have no effect on viruses and aren’t recommended within the first week of developing a cold. About 70% of sinus infections go away within two weeks without antibiotics.

Consider these other forms of treatments instead of antibiotics:

  • These medications are available for over-the-counter purchase. Be careful to only take these medications for a few days at most, as they can cause the return of more severe congestions.
  • Over-the-counter pain relievers Aspirins, acetaminophen or ibuprofen can help relieve temporary pain.
  • Saline nasal spray This is used to spray into your nose several times a day to rinse your nasal passages. It can help to prevent and treat inflammation.

Antibiotics only will be needed if the infection is severe, recurrent or persistent.

The likelihood of bacterial infection increases when:

  • Symptoms last seven days or more, particularly when symptoms initially improve and then worsen.
  • Mucus is thick and yellow or green in color.
  • There is facial or sinus tenderness, particularly if it’s worse on one side of the face.
  • Pain is present in the upper teeth and is worse on one side of the face.

If the infection becomes severe, recurrent or persistent, contact your provider.

What Is The Best Medication For A Sinus Infection

Infographic  Do I need antibiotics?

The best medication for sinus infection treatment is determined by your doctor and varies by case. Below, you can see a comparison of the most common sinus infection medications to learn what to expect.

Best medications for sinus infections
Drug name
Expectorant Oral 1, 1200 mg tablet every 12 hours no more than 2 tablets in 24 hours do not chew or crush. Take with a full glass of water. Headache, nausea, dizziness, drowsiness

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

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What The Treatment For Sinus Infections

In order to eradicate the infection, youll need an antibiotic.

Some people continue to experience a lingering sinus infection even after antibiotics. Sinuses are considered a closed cavity. Removing infection from a closed cavity can require more prolonged antibiotic usage compared to infections that occur in an open cavity .

A sinus infection might require 2-4 weeks of antibiotics plus additional methods to encourage drainage of the sinuses. For a sinus infection to clear completely, we often recommend saline sprays, topical steroid sprays , and decongestants in addition to an antibiotic.

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Recommendations For Nonantimicrobial Therapy

Intranasal steroids have not been conclusively shown to be of benefit in cases of acute sinusitis. One meta-analysis of 4 double-blind, placebo-controlled trials of intranasal corticosteroid treatment in acute rhinosinusitis supports its use as monotherapy or as an adjuvant therapy to antibiotics. However, a randomized, controlled trial of antibiotics and intranasal steroid showed no treatment benefit of intranasal steroids, either alone or with antibiotics.

In a literature study, van Loon et al concluded that only limited evidence exists regarding the efficacy of intranasal corticosteroids in relieving the symptoms of recurrent acute rhinosinusitis. The best evidence, according to the investigators, came from a single study, which had a low bias risk but only moderate directness of evidence according to that report, intranasal corticosteroids may shorten the time needed to achieve symptom relief.

No available data suggest that antihistamines are beneficial in acute sinusitis. In fact, antihistamines may cause harm by drying mucous membranes and decreasing clearance of secretions. Antihistamines are beneficial for reducing ostiomeatal obstruction in patients with allergies and acute sinusitis however, they are not recommended for routine use for patients with acute sinusitis. Antihistamines may complicate drainage by thickening and pooling sinonasal secretions.

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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.

How Long Does A Sinus Infection Last Over The Counter

Do Antibiotics Help With Sinus Infections?

Also, some of my patients spray nasal decongestants, like Afrin. But if used for more than three days, these over-the-counter medicines can cause more sinus swelling. Viral sinusitis should resolve in less than 10 days. But if the sickness is linked to allergies or bacterial infection, symptoms can last longer.

Also Check: Nasal Polyps In Sinus Cavity

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.

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When To Take Antibioticsand When Other Treatments May Work Better

If youve been knocked out by sinus infection symptomsstuffiness, face pain or pressure, nasal dischargeyour doctor might recommend that you wait it out for a week or so before resorting to an antibiotic. And she or he might be right: Antibiotics are often not necessary for clearing up a sinus infection, according to recent research.

As a result, many health experts, including Zara Patel, M.D., a sinus infection expert and assistant professor of otolaryngology at Stanford University in Stanford, Calif., are urging doctors to think twice before prescribing antibiotics for sinus and other respiratory infections.

A 2016 study, published in JAMA, found that people who went to the doctor with a sinus infection were more likely to leave with a prescription for antibiotics than people seeing the doctor for any other reason . But some doctors, pointing to newer evidence, are starting to take a more cautious approach.

For acute sinusitis, there are very well-done studies indicating that antibiotics are not necessary in the vast majority of patients, and most people will be able to clear an infection on their own, Patel says.

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What Are The Best Antibiotics For Sinus Infection Do Doctors Prescribe For You

There are many antibiotics that your doctor or physician may prescribe to help treat your sinus infection. Some of these may even be familiar to you.

  • Ciprofloxacin This drug is used to treat conditions including urinary tract infections, specific types of infectious diarrhea, bone and joint infections, respiratory tract infections, typhoid, and other forms of bacterial infection.
  • Trimethoprim This drug is the brand name for a medication that is a combination of two antibiotics: trimethoprim and sulfamethoxazole that is used to treat bacterial infections. Bactrim works by preventing the growth of bacteria.
  • These antibiotics are effective in treating sinus infection, however, these drugs do carry side effects. You should only be taken according to what your doctor or physician has prescribed. Always follow their instructions to achieve the best results.

    Common Antibiotics For Sinus Infections

    Does my child need antibiotics?

    Antibiotics may be prescribed when symptoms of a sinus infection warrant such treatment. Common antibiotics for sinus infection include:

    • Zithromax
    • Levaquin : Although this drug is often prescribed as a first line of therapy for sinusitis, it has serious side effects and should only be used as a last resort.

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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.

    Antibiotics Are Not A Good First Choice For Sinus Infections

    People often are quick to ask their doctor for an antibiotic prescription when they suffer from a bad flu or sinus infection. These infections can be annoying, with congested noses, headaches, pain all across the face and never-ending mucus. People just want to make the pain and discomfort go away and get on with their lives. Thats understandable, but antibiotics most likely wont better their situation, as has been shown in countless studies. This is because sinusitis, like most infections of the upper respiratory tract, are caused by viruses, not bacteria. And antibiotics only go after bacteria.

    Actually, taking antibiotics can make you feel sicker, since your body is already weakened by the viral infection and now you expose it to the stress of antibiotics side effects. All antibiotics have side effects, so they should only be taken when it makes medical sense, such as when treating a bacterial infection.

    More generally, you want to keep your antibiotics use at a minimum. Because the more you use antibiotics, the more likely you are to get ill in the upper respiratory tract in the future, as the antibiotics not just kill bad bacteria but also the good bacteria in your body that help protect your health.

    It, therefore, is recommended not to immediately treat every sinus infections with antibiotics, but preserve them as heavy ammunition for the most severe cases.

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    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.

    Viral Vs Bacterial Sinus Infections

    Wellness Wednesday: Antibiotics for 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:

    • 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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    Do Antibiotics Treat Sinus Infections

    Antibiotics are a type of medication that stops bacteria from growing and, as a result, improves symptoms of an infection.

    Healthcare providers only prescribe antibiotics for sinus infections that they believe are bacterial.

    Antibiotics dont work on viral or fungal infections, and taking antibiotics when you dont need them can cause unnecessary side effects such as diarrhea, nausea, and stomach pain.

    Plus, taking antibiotics too often can create antibiotic resistance.

    The most common antibiotics prescribed for sinus infections are penicillin-class antibiotics such as amoxicillin or amoxicillin-clavulanate .

    If you have a penicillin allergy, a common alternative is doxycycline.

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    How Is Sinusitis Treated

    Your treatment will depend on the cause of your sinusitis. Most of the time, treatment includes medicines and taking care of yourself at home. Medicines that are used most often include:

    • , such as Sudafed, that are taken as pills or liquids. These can reduce swelling and improve sinus drainage.
    • Over-the-counter pain medicine, such acetaminophen or ibuprofen .
    • Antibiotics, which kill bacteria. Antibiotics will only work if your sinusitis is caused by bacteria. Most of the time, sinusitis is caused by a virus.

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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 from 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.

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