Killer Sinus Infection How To Tell If Yours Is Viral Or Bacterial
You know the symptoms: nasal congestion, facial pressure, pain, fever, too much mucus. Ugh. Its probably another sinus infection.
But is your infection caused by a virus or bacteria and does it really matter?
It does matter. Doctors treat viral and bacterial sinus infections differently. Here is what you need to know about both kinds of infection and how to treat them.
Viral or bacterial?
Most sinus infections are viral, and most are caused by the virus that causes the common cold. How can you tell, based on symptoms, whether your infection is viral or bacterial?
Normally, you can’t.
Symptoms like bad breath, yellow or green mucus, fever and headache are not reliable signs of a bacterial infection. They can be present with viral infections, too. Even your doctor cant tell if your infection is viral or bacterial based solely on symptoms or an exam.
Instead, your doctor looks at symptom duration to determine the source of your infection. A viral sinus infection will usually start to improve after five to seven days. A bacterial sinus infection will often persist for seven to 10 days or longer, and may actually worsen after seven days.
4 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 care:
Use saline spray two to three times per day in each nostril.
Drink eight 8-ounce glasses of fluid per day.
Get plenty of rest.
What to do for chronic sinusitis
Which Antibiotics Are Most Effective For Bacterial Sinusitis
Antibiotics are indicated for sinusitis that is thought to be bacterial, including sinusitis that is severe or involves the frontal, ethmoid, or sphenoid sinuses, since this type of sinusitis is more prone to complications. Penicillins, cephalosporins, and macrolides seem to be equally efficacious. A 5- to 10-day regimen of amoxicillin 500 mg 3 times a day is recommended as first-line therapy.
One study suggests that a single dose of 2 g of extended-release azithromycin may be more effective than a 10-day course of amoxicillin/clavulanate. However, azithromycin is not likely a good choice in sinusitis because symptoms may improve only because of the anti-inflammatory efficacy of the agent and because it has poor efficacy against S pneumoniae and H influenzae. The risk of adverse effects should be weighed against the severity of disease and patient comorbidities prior to initiating antibiotic treatment.
Patterns of bacterial resistance should also be taken into account in the choice of antibiotic.
Lucas JW, Schiller JS, Benson V. Summary health statistics for U.S. adults: National Health Interview Survey, 2001. Vital Health Stat 10. 2004 Jan. 1-134. .
Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005 Dec. 116:S13-47. . .
Lusk RP, Stankiewicz JA. Pediatric rhinosinusitis. Otolaryngol Head Neck Surg. 1997 Sep. 117:S53-7. .
How To Get Rid Of A Sinus Headache
The best way to treat a sinus headache is to help get rid of the mucus in the sinuses. Most sinus infections are caused by viruses that will go away on their own. However, there are some things you can do to help with the symptoms while waiting, like:
Placing a warm compress, like a towel soaked in warm water, over the painful area
Using saline nasal sprays, which keep the inner part of the nose moist
Breathing humidified air, which can also help keep the nasal passages moistened
People often wonder if they need an antibiotic for a sinus infection. Most of the time the infection is caused by a virus, so antibiotics wont help and, even worse, could put you at risk of side effects, like allergic reactions or more severe, antibiotic-resistant infections.
It can be challenging to figure out if a sinus infection is from bacteria. Usually, infections that last over 10 days, or have symptoms that start to worsen after initially getting better, might be caused by bacteria. Some of the symptoms of a bacterial infection are:
Severe pain or pressure
Discolored nasal discharge
Also Check: Mucinex Sinus Pressure And Pain
What Is The Typical Z
Z-Packs are available as a package containing 6 tablets, 250 mg each. Youll start by taking 2 tablets on the first day as a single dose, followed by 1 tablet on days 2 through 5. For children, the dosing is typically based on their weight and what condition is being treated. Theres a similar product called the Tri-Pak that comes with 3 tablets of azithromycin, each containing 500 mg. With this product, you typically take one tablet daily for 3 days.
Its important to take your Z-pack as prescribed. Try to take it at the same time every day youre supposed to take it until you finish the entire prescription regimen. Not completing your treatment can increase the risk that your infection returns and that the bacteria start becoming insensitive to azithromycin, known as antibiotic resistance. This makes the bacteria more difficult to treat.
Recommended Reading: Severe Sinus And Cold Relief
How Long Does It Take For Antibiotics To Kick In For Sinus Infection
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.
Don’t Miss: Get Rid Of Sinus Pressure Headache
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:
Usual Adult Dose For Skin And Structure Infection
Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5Use: Treatment of mild to moderate uncomplicated skin and skin structure infections due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiaeIDSA and NIH Recommendations:Immediate-release:Patients greater than 45 kg: 500 mg orally on day 1, then 250 mg orally once a day on days 2 through 5Patients less than 45 kg: 10 mg/kg orally on day 1, then 5 mg/kg orally once a day for 4 additional daysAlternative therapy for Bartonella infections : 500 mg orally once a day for at least 3 monthsUses:-Treatment of bacillary angiomatosis and cat scratch disease-Alternative therapy for Bartonella infections
Recommended Reading: I Think I Have Sinus Infection
The Rise Of Antimicrobial Resistance
Today, doctors have a better understanding of which antibiotics are best used for which illnesses and how the overuse of antibiotics like Z-paks contribute to antibiotic resistance. The more we use antibiotics inappropriately, the more we create bacteria that are resistant.
Its interesting that we used to think of azithromycin as a cure-all for everything, because thats what led to overprescribing and its demise, said Emir Kobic, a clinical pharmacy specialist in infectious diseases at Banner – University Medical Center Phoenix. Its no longer the first line antibiotic physicians should be prescribing for patients with community-acquired pneumonia where Streptococcus pneumoniae still tends to be the most common bacterial culprit.
The inappropriate use and overuse of Z-paks has led Streptococcus pneumoniae resistance rates to rise as high as 20-30% in America, Dr. Kobic said. This stat should be concerning, because the majority of pharmaceutical companies are not investing to develop new antibiotics, and if they are patients will be paying higher co-pays and out of pocket costs on future antibiotics.
When To Consider Antibiotics For Sinus Infections
AAAAI advises that antibiotics for sinus infections should be considered only if you develop a fever of 102° F or higher, you have severe face pain and tenderness, your symptoms last longer than a week or so, or your symptoms improve and then worsen again.
Some patients with acute sinusitis do need antibiotics, and if they continue with a worsening infection without treatment, they can suffer dramatic complications such as loss of vision, meningitis, or brain abscess, Patel says.
If your doctor says you need an antibiotic, ask for generic amoxicillin/clavulanate, according to guidelines from UpToDate, which provides evidence-based treatment information to healthcare providers. Its usually the best choice and works as well as more expensive brand-name antibiotics.
Avoid taking fluoroquinolones, a group of antibiotics that includes ciprofloxacin and levofloxacin . Although widely used, the antibiotics are inappropriate for treating sinus infections and they pose serious risks.
In 2016, after a safety review, the Food and Drug Administration linked fluoroquinolones to disabling and potentially permanent side effects. The agency advised against using the drugs to treat common illnessesbronchitis, sinus infections, and urinary tract infections.
Read Also: Sore Throat And Sinus Pain
How Should I Take Azithromycin
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Azithromycin oral is taken by mouth. Azithromycin injection is given as an infusion into a vein, usually for 2 days before you switch to azithromycin oral. A healthcare provider will give you this injection.
You may take azithromycin oral with or without food.
Shake the oral suspension before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device .
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Azithromycin will not treat a viral infection such as the flu or a common cold.
Store at room temperature away from moisture and heat. Throw away any unused liquid medicine after 10 days.
What Does A Z
A Z-pack is a regimen of prescription antibiotics used to treat bacterial infections. Antibiotics, including the Z-pack, do not treat viruses, which are the cause of most colds and even bronchitis.
Azithromycin has an average rating of 7.1 out of 10 from a total of 55 ratings for the treatment of Upper Respiratory Tract Infection. 65% of those users who reviewed Azithromycin reported a positive effect, while 25% reported a negative effect. 55 ratings from 54 user reviews.
Recommended Reading: Allergy Asthma Sinus Center Shot Room Hours
How Long To Take It
Take your azithromycin for the duration prescribed by your provider.
Usually, this is between 3-10 days. Make sure to take the medication on time and complete the full treatment course before discontinuing the drugeven if youve begun to feel better.
Starting and quitting the drug before the specified day can cause bacteria to become resistant to antibiotics.
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.
Recommended Reading: Best Tea For Sinus Infection
What Is The Most Important Information I Should Know About Azithromycin
You should not use azithromycin if you are allergic to it, or if you have ever had:
- jaundice or liver problems caused by taking azithromycin or
- a severe allergic reaction to similar drugs such as clarithromycin, erythromycin, or telithromycin.
Azithromycin oral should not be used to treat pneumonia in people who have:
- cystic fibrosis
- an infection after being in a hospital
- an infection in the blood
- a weak immune system or
- in older adults and those who are ill or debilitated.
Tell your doctor if you have ever had:
- low levels of potassium in your blood
- a heart rhythm disorder or
- long QT syndrome .
It is not known whether this medicine is effective in treating genital ulcers in women.
Tell your doctor if you are pregnant or breastfeeding. Taking azithromycin while breastfeeding may cause diarrhea, vomiting, or rash in the nursing baby.
Azithromycin is not approved for use by anyone younger than 6 months old. Azithromycin should not be used to treat a throat or tonsil infection in a child younger than 2 years old.
Also Check: Best Home Remedies For Cold And Sinus
When Antibiotics Are Appropriate Treatment
In addition, antibiotics can be given to those whose symptoms have gotten worse or those who show no improvement after seven days.
If antibiotics are given, a 10- to 14-day course is recommended, according to the practice guidelines. Amoxicillin or amoxicillin clavulanate are typically the first choice for people who are not allergic to penicillin.
You May Like: How To Get Rid Of A Bad Sinus Infection
Usual Adult Dose For Legionella Pneumonia
Community-acquired pneumonia:Oral:-Immediate-release: 500 mg orally as a single dose on day 1, followed by 250 mg orally once a day on days 2 to 5-Extended-release: 2 g orally once as a single doseParenteral: 500 mg IV once a day as a single dose for at least 2 days, followed by 500 mg orally to complete a 7- to 10-day course of therapyComment: Extended-release formulations should be taken on an empty stomach.Uses:-Treatment of mild community acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy-Treatment of community-acquired pneumonia due to C pneumoniae, H influenzae, Legionella pneumophila, Moraxella catarrhalis, M pneumoniae, or S pneumoniae in patients who require initial IV therapy
Read Also: What Can Be Done For Sinus Infection
What Ear Drops Are Good For Ear Pain
Antipyrine and benzocaine otic is used to relieve ear pain and swelling caused by middle ear infections. It may be used along with antibiotics to treat an ear infection. It is also used to help remove a build up of ear wax in the ear. Antipyrine and benzocaine are in a class of medications called analgesics.
You May Like: How To Help Sinus Drainage In Throat
Possible Risks And Side Effects Of Azithromycin
The most common side effects of azithromycin are not life-threatening for most people.
Still, its worth knowing what they are so you dont panic, and can get help from your doctor if needed.
Side effects you may experience with azithromycin are:
- Upset stomach
- Anti-diarrheal medications
- HIV medicines
If you take any of these medications, your provider may need to prescribe alternative medication or recommend pausing them for the duration of your antibiotic treatment.
How To Use Zithromax
Take this medication by mouth as directed by your doctor, usually once daily with or without food. You may take this medication with food if stomach upset occurs. The dosage is based on your medical condition and response to treatment.
For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time every day.
Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.
Antacids containing aluminum or magnesium may decrease the absorption of azithromycin if taken at the same time. If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before or after taking azithromycin.
Tell your doctor if your condition persists or worsens.
Read Also: When To See A Doctor About A Sinus Infection
If You Think You Have A Sinus Infection
If you feel you are experiencing sinus infection symptoms, make an appointment with your PartnerMD physician, and do not attempt to treat symptoms on your own. While you may initially be recommended OTC treatments, only your doctor can accurately diagnose your symptoms, and prescribe the right treatment for relief.
Have a question about your sinus infection symptoms? Contact us today to see if a relationship with a concierge doctor could be beneficial.
7001 Forest Avenue, Suite 302
Richmond, VA 23230