People With Sinus Infections Stay On Antibiotics Too Long
By Lisa Rapaport, Reuters Health
5 Min Read
– Most people prescribed antibiotics for sinus infections are on treatment courses of 10 days or longer even though infectious disease doctors recommend five to seven days for uncomplicated cases, a U.S. study suggests.
Researchers examined data from a sample representing an estimated 3.7 million adults treated for sinusitis and prescribed antibiotics in 2016. Overall, 70 percent of antibiotics prescribed were for 10 days or longer, the study found.
Any time antibiotics are used, they can cause side effects and lead to antibiotic resistance, said senior study author Dr. Katherine Fleming-Dutra, deputy director of the Office of Antibiotic Stewardship at the U.S. Centers for Disease Control and Prevention in Atlanta.
This is why it is so important to only use antibiotics when they are needed and to use the right antibiotic for the minimum effective duration, Fleming-Dutra said by email.
Common side effects of antibiotics can include rash, dizziness, nausea, diarrhea and yeast infections, she said. More serious side effects may include life-threatening allergic reactions and Clostridium difficile infection, which causes diarrhea that can lead to severe colon damage and death.
Antibiotic resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them and can make infections harder to treat.
SOURCE: bit.ly/2Gpq29Z JAMA Internal Medicine, online March 26, 2018.
Side Effects Of Using Amoxicillin For Sinusitis
Every drug comes with its own set of side effects. And, this antibiotic also has. Some of the most common side effects of using this drug are:
- Bloating
- Metallic taste in the mouth
- Tiredness
Prolonged use of this medication could cause dark urine, abdominal pain, and skin rashes/hives. If you experience any such condition, please visit the doctor.
Feel Better Sooner Without Antibiotics
Instead of taking antibiotics for sinusitis, Consumer Reports chief medical adviser, Marvin M. Lipman, M.D., recommends that you get plenty of rest, rinse your nose with a saltwater sinus rinse or spray, drink warm fluids, and inhale steam from a hot bath, shower, or kettle. For pain, he says, try an over-the-counter pain reliever such as acetaminophen or ibuprofen .
If needed, your doctor can prescribe a prescription corticosteroid spray, such as fluticasone or triamcinolone. A systematic review published in JAMA in 2015 found that after saline irrigation, the second-best treatment for chronic sinusitis was a topical corticosteroid spray for a few days.
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When Do We Need Antibiotics For Sinus Infection
Antibiotics are not needed for many sinus infections, but your doctor can decide if you need an antibiotic. You doctor may recommend antibiotics if:
Most sinus infections usually get better on their own without antibiotics. When antibiotics arent needed, they wont help you, and their side effects could still cause harm. Side effects can range from minor issues, like a rash, to very serious health problems, such as antibiotic-resistant infections and C. diff infection, which causes diarrhea that can lead to severe colon damage and death.
Amoxicillin For Sinus Infection
Amoxicillin belongs to penicillin antibiotics and is used in range of infections. It can be administered either orally or intravenously. Amoxicillin is also available in a form of a nasal spray. This is a highly effective antibiotic against many bacteria. One of the infections that is treated with amoxicillin is sinus infection.
Amoxicillin and Sinus Infection
Sinus infection is a common infection and it affects people of all ages. It can occur once or tends to reoccur when it turns into a chronic form. Sinus infection caused by bacteria does not respond to home remedies and requires proper antibiotic treatment. One of antibiotics prescribed in patients suffering from sinus infection is amoxicillin. The drug is very effective and can successfully eradicate harmful bacteria. It also does not have many side effects. Amoxicillin is forbidden in patients who are allergic to the medication or any other penicillin drug.
Only in case the patient does not respond to treatment with amoxicillin this points to the resistance of the bacteria to the drug and it needs to be replaced with some other antibiotic.
Amoxicillin Dosage for Sinus Infection
The single dose for adults in case of sinus infection is 500 mg. The drug is taken 3-4 times a day . The entire length of the treatment depends on the patient’s general health, age, comorbidities and the severity of the sinusitis.
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How Effective Is Amoxicillin For A Sinus Infection
Many sinus infections that are caused by bacteria will not go away with the use of over-the-counter medications and home treatments. For this reason, a doctor will often prescribe amoxicillin for a sinus infection. The antibiotic is generally taken over a period of 10 days to two weeks, during which time the medication will most likely succeed in overcoming the illness.
A sinus infection occurs when the sinuses, air-filled chambers of bone connected to the nasal passages, become inflamed, causing pressure in the head, headaches, nasal discharge, and other symptoms. If the infection is persistent and occurs with severe symptoms, it may be caused by a bacterial infection. In many cases, amoxicillin is prescribed to take care of this problem.
Amoxicillin for a sinus infection is available in the form of a pill, a liquid, or a nasal spray. Adults are generally prescribed the pill form of the antibiotic and are instructed to take a relatively high dose of the antibiotic for 10 to 14 days. In general, children and those who are unable to swallow a whole pill are given the liquid form of amoxicillin for sinus infections. If a sinus infection is considered chronic, or long-lasting, lower doses of this antibiotic may be prescribed for a longer length of time.
When Antibiotics Are Appropriate Treatment
Antibiotics may be given to people who are less able to fight off infection, such as those with diabetes, or serious heart or lung disease.
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.
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Signs And Symptoms Of Sinus Infection Or Sinusitis
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.
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When To Seek Medical Care
See a doctor if you have:
- Severe symptoms, such as severe headache or facial pain.
- Symptoms that get worse after initially improving.
- Symptoms lasting more than 10 days without improvement.
- Fever longer than 3-4 days.
You should also seek medical care if you have had multiple sinus infections in the past year.
This list is not all-inclusive. Please see a doctor for any symptom that is severe or concerning.
Other conditions can cause symptoms similar to a sinus infection, including:
- Seasonal allergies
- Colds
What Are The Six Types Of Sinusitis And Sinus Infections
Sinusitis may be classified in several ways, based on its duration and the type of inflammation . The term rhinosinusitis is used to imply that both the nose and sinuses are involved and is becoming the preferred term over sinusitis.
- Acute sinus infection usually lasts less than 3-5 days.
- Subacute sinus infection lasts one to three months.
- Chronic sinus infection is greater than three months. Chronic sinusitis may be further sub-classified into chronic sinusitis with or without nasal polyps, or allergic fungal sinusitis.
- Recurrent sinusitis has several sinusitis attacks every year.
There is no medical consensus on the above time periods.
- Infected sinusitis usually is caused by an uncomplicated virus infection. Less frequently, bacterial growth causes sinus infection and fungal sinus infection is very infrequent. Subacute and chronic forms of a sinus infection usually are the result of incomplete treatment of an acute sinus infection.
- Noninfectious sinusitis is caused by irritants and allergic conditions and follows the same general timeline for acute, subacute, and chronic as infectious sinusitis.
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Sinus Anatomy And Function
1. Benson V, Marano MA. Current estimates from the National Health Interview Survey, 1992. Vital Health Stat. 1994 189:1269….
2. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995 273:2149.
3. Bamberger DM. Antimicrobial treatment of sinusitis. Semin Respir Infect. 1991 6:7784.
4. Dingle JH, Bodger GF, Jordan WS Jr. Illness in the home: a study of 25,000 illnesses in a group of Cleveland families. Cleveland Press: Case Western Reserve University, 1964:347.
5. Wald ER. Sinusitis in children. N Engl J Med. 1992 326:31923.
6. Hinriksdottir I, Melen I. Allergic rhinitis and upper respiratory tract infections. Acta Otolaryngol Suppl. 1994 515:302.
7. Gwaltney JM Jr, Scheld WM, Sande MA, Sydnor A. The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis: a fifteen-year experience at the University of Virginia and review of other selected studies. J Allergy Clin Immunol. 1992 90:45761.
8. Winther B, Gwaltney JM. Therapeutic approach to sinusitis: anti-infectious therapy as the baseline of management. Otolaryngol Head Neck Surg. 1990 103:8769.
9. Evans FO Jr, Sydnor JB, Moore WE, Moore GR, Manwaring JL, Brill AH, et al. Sinusitis of the maxillary antrum. N Engl J Med. 1975 293:7359.
10. Evans KL. Diagnosis and management of sinusitis. BMJ. 1994 309:141522.
Case & Commentary: Part 3
The patient’s hospital course was marked by multiorgan failure, septic shock, and spontaneous bowel perforation requiring hemicolectomy. Examination of the bowel showed Aspergillus, leading to a diagnosis of disseminated aspergillosis. Despite aggressive antifungal therapy, the patient ultimately succumbed to overwhelming infection and died.
This patient suffered a tragic outcome likely related to inappropriate prescribing of antibiotics. While the complications and ultimate outcome of this case are exceedingly rare, unfortunately, the problem of inappropriate antibiotic prescribing remains common. Over the past decade, antibiotic prescribing for ARIs has decreased in response to publicity and education regarding antimicrobial resistance. However, prescribing rates for viral infections remain high: in 2002, nearly half of adults with nonspecific ARIs were still prescribed antibiotics. Limited success in reducing overall antibiotic prescribing may be counteracted by a marked increase in prescribing of broad-spectrum antibiotics, the use of which doubled during the 1990s.
Take-Home Points
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What Home Remedies Help Soothe Sinus Infection Or Sinusitis Symptoms
Sinus infections caused by viruses can use home treatments such as pain and fever medications , decongestants, and mucolytics. In addition, some health care professionals suggest nasal irrigation or a sinus rinse solution to help relieve symptoms of sinus infections, even chronic sinusitis symptoms. This irrigation is accomplished with a “Neti-Pot” or a sinus rinse kit . The last reference of this article shows a video of a sinus rinse procedure. In 2012, the FDA issued a warning about the use of Neti-Pots. The FDA cautions people not to use untreated tap water for rinsing, as contaminated tap water rinses lead to two deaths.
Bacterial and fungal sinus infections usually require antibiotic or antifungal therapy so home treatments without them are often not successful. However, some authors suggest home treatments may reduce symptoms after medical therapy has begun some healthcare professionals recommend nasal irrigation after sinus surgery.
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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.
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.
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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 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 the 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.
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