Got a Sinus Infection? Antibiotics Probably Aren’t the Answer

Posted on Tue, Mar 06, 2012

By eMedical Urgent Care Woman SneezingIt’s that time of year again. Yes, it’s been an unusually mild winter, but coughing, sneezing and stuffy noses are everywhere. And some of those folks have not just a cold, but sinusitis. And if you’re among them, it’s important to know what’s causing your illness– and how to treat it properly. Sinus infections, known as sinusitis, are one of the most frequent reasons patients come to our urgent care centers. And while many patients expect to be treated with antibiotics, both recent medical literature and  medical organizations that develop treatment guidelines and recommendations for these types of illnesses, such as the American Academy of Otolaryngology and the American Academy of Allergy, Asthma and Immunology, have concluded that antibiotic treatment of sinusitis is not in fact indicated in most patients and have set clear diagnostic standards for their appropriate use. Sinus Infections: They Are All Around You

  • In 2010, nearly 30 million adults were diagnosed with sinusitis, according to the Centers for Disease Control and Prevention (CDC).
  • These patients accounted for nearly 13 million outpatient visits.
  • Children aged 6 months to 3 years average six viral upper respiratory infections (URIs) each year, and about 8 percent of these will be complicated by acute bacterial sinusitis.
  • Women are more likely to experience sinus infections probably because they have more contact with young children.
  • It is estimated that sinusitis costs patients about $6 billion dollars annually in health care costs.
Symptoms and Causes By definition, sinusitis is an inflammation of the cavities in the skull and facial bones that empty into the nose. Sinusitis can be further classified based on both its severity and its cause, with approximately 80 percent of cases being infectious, and the remainder allergic. Differentiating between the two potential causes is sometimes difficult, particularly in the spring and fall when allergies are likely to flair. The sinuses are normally filled with air, and the small amount of mucus they produce drains through very small openings, passing into the nose unnoticed. But when those openings become clogged, the mucus backs up, the sinus fills with mucus, and the symptoms of sinusitis appear, including:
  • Nasal congestion
  • Facial pain or pressure—characteristically aggravated by leaning forward
  • Decreased sense of smell
  • Facial swelling
  • Redness, including nose, cheeks and eyelids
  • Postnasal drip
  • Persistent cough
  • Foul mucus discharge
  • Ear pain
  • Headache
But I Want an Antibiotic! Of those patients who develop viral upper respiratory infections (URIs or “colds”), 90 percent have some involvement of the sinuses, but only 5 to 10 percent of these cases will progress to acute bacterial sinusitis, when bacteria enter the sinuses and multiply, at which point the use of an antibiotic is warranted. Although there are no precise definitions, the general consensus is that acute bacterial sinusitis is more likely if URI symptoms are not improving within seven to 10 days, or if at that point symptoms are worsening or severe. So because sinusitis is usually caused by either a virus or an allergy—neither of which responds to antibiotics, your doctor will provide symptomatic treatment. Antibiotics will not only not be useful, but they actually could cause harm (side effects, allergic reactions, bacterial resistance) and should generally be used only if:
  • Your symptoms last more than 10 days or are worsening (for example, if your face is swelling or your teeth begin to hurt)
  • You have an underlying medical condition (such as diabetes, history of chronic sinusitis or recent bacterial sinusitis), or
  • Your symptoms are more severe than typical
Treating the Symptoms of a Sinus Infection To treat the symptoms of a sinus infection, you can make use of the following to help make yourself comfortable while the infection clears naturally:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can relieve pain and help shrink mucus membranes. If you can’t take NSAIDs, acetaminophen can be used for pain relief.
  • Maintaining adequate hydration can be helpful, both internally (drink a lot of fluids) and externally, through the use of a humidifier. This can help loosen mucus and aid natural drainage.
  • Decongestants help by decreasing swelling. Pseudoephedrine or phenylephrine are oral decongestant and are available without prescription. However, these should be used with caution or under supervision of your physician if you have a history of hypertension or heart problems. Decongestants in the form of a long-acting nasal spray, such as oxymetazoline (Afrin and others), also are available without a prescription and can help drain blocked sinuses. They should not be used for more than three consecutive days to avoid rebound congestion, a condition in which overuse actually leads to a worsening of the congestion.
  • Medications known as mucolytics—such as guiafenesin—are said to work by loosening mucus secretions, but while frequently recommended, they have not been proven to be effective.
  • Nasal steroid sprays, available only by prescription, help alleviate symptoms by shrinking swollen and inflamed mucus membranes.
Using Antibiotics Properly If your doctor does prescribe an antibiotic to treat your sinus infection, the initial antibiotic of choice is generally amoxicillin. If you are allergic to penicillin, clarithromycin is a good alternative. Antibiotics for sinusitis are usually prescribed for at least 10 days, since shorter courses haven’t been proven as effective. If you have recurrent or severe sinusitis, secondary treatment could include an amoxicillin/clavulanic acid combination (Augmentin) or a fluoroquinolone (such as levofloxacin or ciprofloxacin). The course of treatment should be at least 10 days but could be 14 or 21 days depending on severity and how often you develop a sinus infection. In summary, most cases of sinusitis are viral in nature. Treatment with antibiotics is generally not helpful and not recommended. Treating your symptoms over the first seven days is the best approach. If your symptoms don’t improve in seven to 10 days, if the symptoms are severe or worsening, or if you have other medical issues, contact your doctor. eMedical Urgent Care is available seven days a week to evaluate you or your children to help decide the best and safest treatment to get you feeling better quickly. If you need medical attention for a non-life-threatening illness or injury, eMedical Urgent Care is open during the evening hours to treat walk-in patients. If you have questions about medical conditions, download iTriage from the iTunes or Android Marketplace, or check out for your healthcare answers.

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