Most Sinus Infections Dont Require Antibiotics
Ah, . The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.
It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, theres the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
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.
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:
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A runny nose
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A sore throat
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A cough
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.
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Diarrhea
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First Line Of Defense Against Sinusitis: Nasal Irrigation
One of the simplest, cheapest, and most effective ways to prevent and treat sinus problems is nasal irrigation. Using a homemade solution, you can often relieve sinusitis symptoms, reduce reliance on nasal sprays and antibiotics, and improve your quality of life. At least once a day, follow these steps:
How To Tell If You Have An Actual Sinus Infection
Even though we often say we have a sinus infection even if its just inflammation or an allergic response, there are symptoms of an actual infection that may be treatable with antibiotics. Nasal congestion and pain under the eyes or around the temples are, of course, main symptoms, but others include the loss of the sense of smell, green nasal discharge, mucus dripping down your throat, cough, fever, fatigue, sore throat, and even bad breath.
Sometimes, a sinus infection will clear up without intervention, but if you develop a fever of 100.4 degrees or higher, have your symptoms for 10 or more days, notice that your symptoms are getting worse and are not improved by OTC medications, or you have multiple infections in a years time, you should seek medical treatment as soon as possible.
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Should You Visit A Specialist
If your sinus infection just wont go away or keeps coming back, it may be time to see an ear, nose, and throat specialist. An ENT treats conditions of the ear, nose, throat, head, face, and neck. It may be time to see an ENT if:
- Youve completed several courses of antibiotics without success
- Your doctor suspects nasal polyps or another blockage of the nasal cavity
- You have chronic sinusitis that lasts longer than 12 weeks
Living with a sinus infection is miserable and living with a sinus infection for weeks on end is worse. Contact your doctor or an ENT to get the treatment you need.
Why Do I Lose My Taste During A Sinus Infection
Unlike a novel coronavirus infection, a sinus infection doesnt usually cause a direct loss of taste. Instead, the sense of smell is the first to go.
Sinus infections cause inflammation within the nasal cavities and passageways. This swelling blocks the flow of air through your nose and prevents it from reaching the olfactory nerve thats responsible for your sense of smell.
Since air carries odor particles, when it cant reach your olfactory nerve, youre not going to be able to smell anything.
Because your sense of taste relies so heavily upon your ability to smell, the inflammation caused by a sinus infection can lead to a dulled sense of taste.
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I’m A Doctor And Here’s What A Faint Line On Your Covid Test Really Means
Regardless of your symptoms, it may be best to get a Covid test just to check and Health Secretary Sajid Javid has urged Brits to take a lateral flow test before going out and meeting with friends.
If it is positive, there are strict self-isolation rules. But if it is negative, experts say if you are unwell, its best to stay away from people to prevent spreading bugs, anyway.
Follow our Omicron Covid live blog for all the latest news & stories
Even if you are adamant you have a cold, it could be Covid, and vice versa.
We get it – its becoming hard to keep up with advice and when to take your runny nose seriously.
Here, we give an idea of what to expect with each virus at the moment – from the latest super Covid strain Omicron to the classic common cold.
Is It Possible To Get Over A Sinus Infection Without Antibiotics
While antibiotics are often recommended treatments for sinus infections, this medication isnt a one-size-fits-all solution for every patient. While many sinus infections are caused by bacteria or fungus, viral infections can also be the root cause.
For example, if the root cause is a viral infection, then antibiotics wont help in clearing up the infection. You will need to wait for the virus to run its course. Sometimes a secondary bacterial infection develops with the virus. Have you come down with a head cold, then the congestion worsens, and sinus pain develops a week later? The symptoms of the viral infection likely created the perfect conditions for the development of a bacterial infection in the sinuses.
In fact, with the rates of antibiotic resistance increasing, doctors are working to reduce the number of antibiotic prescriptions. There are times when antibiotics are needed for treatment. But each patient needs to be evaluated individually before jumping to conclusions about treatment options.
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How An Ent Treats A Sinus Infection
If you have a lingering sinus infection after antibiotics, an ENT doctor often elects to be more aggressive in treatment than a primary care physician. They may prescribe longer courses of antibiotics, stronger medications, or recommend a procedure to open the sinuses.
If you have persistent sinus problems, the sinuses must first be unblocked. Sometimes, thats done through a simple balloon sinuplasty and irrigation. Other times, unblocking the sinuses requires a more aggressive procedure like endoscopic sinus surgery. We opt for this procedure when the sinuses become so blocked, tissue and bone need to be removed to create a wider opening.
If youre dealing with a lingering sinus infection, dont let it progress to a more serious issue. Call your ENT so they can discover whats at the root of your problem and find a treatment to bring you relief.
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:
- Viruses
- Nasal polyps or deviated septum causing nasal obstruction
- Irritants/pollutants
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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Is Your Sinus Infection Acute Or Chronic
A short-term sinus infection is often referred to as acute sinusitis. Most cases of acute sinusitis last about a week, but this type of short-term sinus infection can last up to four weeks. If you suffer from a sinus infection that lasts longer than 12 weeks despite treatment from your doctor, its considered chronic sinusitis.
When Antibiotics Are In Order
The main reason to prescribe antibiotics is for patient comfort, Dr. Sindwani says. The medical field used to be more convinced than it is today than untreated sinusitis would inevitably become a chronic issue, he says.
We dont think that way as much, he says. We dont know that an untreated acute sinusitis, if left untreated, will grumble along and cause people to have a chronic sinus infection.
Some people think thats two separate things, with chronic sinusitis more likely due to underlying issues like allergies or immune problems.
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Can Sinusitis Be Prevented
Simple changes in your lifestyle or home environment can help lower the risk of sinusitis. For example, during the winter, use a humidifier to keep home humidity at 45%50%. This will stop dry air from irritating the sinuses and make them less of a target for infection. Clean your humidifier often to prevent mold growth.
How Do You Diagnose Chronic Sinusitis
The presence of two or more of the listed symptoms for at least three months raises the suspicion of a chronic sinus infection.
In such cases, we will evaluate you to confirm the diagnosis. This involves applying pressure on your sinuses to elicit tenderness. If the tenderness is positive, your sinuses are likely to be inflamed. We will then take a peek into your nose using a small flexible scope, and check for nasal polyps, pus-filled discharge, and deviated septum.
We may also recommend nasal endoscopy. This is an office procedure that enables us to view the interior of your nose and sinus passages. Its done with an instrument called an endoscope, which is a thin, flexible tube with a tiny camera and a light. We will pass this scope into your nose and sinuses to look inside. Nasal endoscopy allows us to detect any swelling and polyps, as well as collect discharge from the infected area. This can help spot the cause of your infection and whats the best way to treat it.
If need be, we may also perform imaging in the form of a computed tomography to look for further problems.
Allergy skin tests look for allergic causes and to check for problems within your immune system may also be done.
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Sinus Infection Vs Covid
Some sinus infection and COVID-19 symptoms may overlap. Both illnesses can cause a fever, headaches, nasal congestion, fatigue or a sore throat. Symptoms unique to COVID-19 include body aches, nausea, shortness of breath and vomiting. Learn the difference between the cold, flu and COVID-19 based on your symptoms.
How Long Do Sinus Infections Last
Many variables affect the duration of sinus infections. Most last more than 10 days, but when a sinus infection lasts more than twelve weeks, it is considered chronic sinusitis.
If after 10 days, your symptoms have not improved, see your primary care doctor. You may have an acute sinus infection.If it lasts four weeks, you potentially have a sub-acute sinus infection that needs more aggressive treatment.
If symptoms last over 12 weeks, youre likely dealing with a chronic infection. After such prolonged symptoms, it can be difficult to distinguish sinus headaches from migraine headaches from severe allergies. After 12 weeks, diagnosing and treating the issue requires the medical expertise of an ENT.
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How Long Do Antibiotics Take To Work On Sinus Infections
Often, sinus infections are treated with antibiotics. However, your doctor will determine the best treatment based on the root cause of your sinus infection. If antibiotics are prescribed, you may want to know how long it will be before you start to experience relief from symptoms.
Read on to find out how sinus infections are diagnosed, when your doctor may prescribe antibiotics, and how long it will take antibiotics to take effect.
How Can You Tell If You Have An Acute Sinus Infection
Its tempting to label every nasal issue as a sinus infection, but thats not always the case. Common symptoms of acute sinusitis include:
- Headaches and sometimes, toothaches
- Fever
- Halitosis
Many people believe that green snot means you have a bacterial sinus infection, curable only with antibiotics. Not true. Sage-colored mucus is common with viral infections and allergies and can happen when snot sits in your face for a while before being expelled.
A trip to your doctor may be necessary if you have a bacterial infection, but it can often be difficult to distinguish between that and a viral infection. If your symptoms last longer than 10 days or improve before worsening again, call your HCP.
If you suddenly experience any of these symptoms, its a sign to seek medical attention immediately, even if theyve been present for fewer than seven days:
- Abrupt vision changes
- Continual high fever
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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.
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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