Viral Vs Bacterial 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:
- Over-the-counter such as pseudoephedrine
- 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.
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.
Do I Need Antibiotics
Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses . Antibiotics only work against bacteria but not viruses. Using antibiotics when they are not needed can lead to antibiotic resistance. This is when overuse of antibiotics encourages the growth of bacteria that cant be controlled easily with drugs. That makes you more at risk of antibiotic-resistant infections in the future and makes antibiotics less effective for everyone.
- Antibiotics are considered when symptoms last longer than 10 days, start to improve but then worsen again, or are very severe such as a fever over 39°C, extreme pain and tenderness over your sinuses, or signs of a skin infection, such as a hot, red rash that spreads quickly.
- If you are given antibiotics, finish the full course.
- Read more about antibiotics for sinusitis Choosing Wisely, NZ
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Otc Medicine For Sinus Congestion
When your sinuses become inflamed and congested, this means that the tiny, air-filled spaces that are connected to your nasal cavity have been blocked or are unable to drain normally. This buildup of mucus then causes a feeling of pressure or fullness in your forehead, eyes, or jaw. Luckily, OTC medications, such as acetaminophen or ibuprofen, can alleviate pain caused by the pressure buildup.
Here are the most common types of OTC medication for sinus congestion:
1. Decongestant: Nasal decongestants are available in tablets, liquids, and nasal sprays and work by reducing blood flow to the sinuses, ultimately reducing nasal swelling and inflammation. Popular nasal decongestants include:
- Phenylephrine with brand names Sudafed PE, Vicks Sinex, and Pretz-D.
- Pseudoephedrine with brand names Sudafed, Dimetapp Decongestant, and 12 Hour Cold Maximum Strength.
2. Pain reliever: There are two main categories of pain relievers:
3. Antihistamines: Antihistamines are commonly used to treat allergies, but they can be used to treat stomach problems and the common cold among other ailments. Antihistamines work by blocking the effects of histamine, which your immune system releases to protect against foreign invasions. Histamines cause symptoms like inflammation, congestion, a runny nose, and sneezing. So antihistamines are designed to alleviate those symptoms. Popular antihistamines include cetirizine and fexofenadine .
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Should You Treat A Sinus Infection With Antibiotics
Over the past few months Ive seen patient after patient drag themselves to the clinic with coughing, sneezing, headaches and green or yellow nasal discharge, sometimes accompanied by ear and tooth pain. Some people with infection may experience fevers, chills or night sweats signs that the body is fighting a virus or bacteria. These are symptoms I expect as a primary care doctor especially during the spring seasons. They are the telltale signs of sinusitis. But if that sums up symptoms you have, do you need antibiotics? The question may be more complicated than you think.
Each year, more than 30 million Americans endure sinusitis an inflammation of sinus spaces surrounding the nose that makes it difficult to drain fluid that normally flows through the sinuses. Much like a detective weighing clues, us health providers use symptom severity and duration to determine the cause of a patients sickness.
The World Health Organization has called antibiotic resistance one of the biggest threats to global health, saying misuse of antibiotics in humans and animals is accelerating the process.
At a health professionals discretion, antibiotics can be prescribed if a person appears very sick or has any underlying chronic disease that may make them prone to becoming sicker.
Left: With spring comes sinus infections. And many questions from my patients about how to best to treat them. Photo by Michael Heim / EyeEm and Getty Images
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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.
For Some People Medications Arent Enough To Clear Up Sinus Infections Here Are Some Steps You Can Take If Youve Had Enough
Sinus infections are no fun. They cause pressure, swelling and congestion that can be painful and even debilitating. And if one acute infection isnt bad enough, some people get them over and over again. This is called chronic rhinosinusitis . There are surgical procedures that can treat these repeat infections but when are they necessary?
If you have a serious sinus infection, the first step is to see what you can do to avoid surgery, which should be viewed as a last resort. Consider your home and workplace environment avoid smoke and allergy triggers, and use humidifiers to moisten the air, as dry air can be irritating. Seek treatment for allergies, which may include regular shots. Practice cold prevention by washing your hands often, avoiding sick people and treating illness if it occurs. Also, its a good idea to get a flu vaccine, as cold and flu infections can create a breeding ground for rhinosinusitis.
If you continue to get sinus infections after taking these preventive measures, the next step is to receive medical therapy from an ear, nose and throat specialist. This will likely require several weeks of antibiotics, steroid medications and nasal sprays and irrigations. If you still dont respond to treatment, your doctor may perform a CT scan to see whats causing the infection to persist.
You might need surgery if you have badly damaged sinus tissue, benign growths , a fungal infection or structural problems that are preventing your sinuses from draining.
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Treatment For Sinusitis From A Gp
If you have sinusitis, a GP may be able to recommend other medicines to help with your symptoms, such as:
- steroid nasal sprays or drops â to reduce the swelling in your sinuses
- antihistamines â if an allergy is causing your symptoms
- antibiotics â if a bacterial infection is causing your symptoms and you’re very unwell or at risk of complications
You might need to take steroid nasal sprays or drops for a few months. They sometimes cause irritation, sore throats or nosebleeds.
A GP may refer you to an ear, nose and throat specialist if, for example, you:
- still have sinusitis after 3 months of treatment
- keep getting sinusitis
- only have symptoms on 1 side of your face
They may also recommend surgery in some cases.
When Should I Call The Doctor
- a cold that lasts for more than 710 days without improvement
- a cold that seems to be getting worse after 7 days of symptoms
- symptoms of allergies that dont clear with the usual allergy medicine
Also call if your child shows any other signs of worsening sinusitis, such as:
- pain or pressure in the cheeks or around the eyes
- swelling around the eye
- 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.
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What Is A Sinus Infection
A sinus infection, medically known as sinusitis or rhinosinusitis, occurs when your nasal cavities become infected, swollen, and inflamed. Fluid buildup in the sinuses can cause germs to grow, leading to a sinus infection.
Sinusitis is usually caused by a virus and often lasts even after other upper respiratory symptoms are gone. In some cases, bacteria or, rarely, fungus may cause a sinus infection.
Other conditions such as allergies, nasal polyps, and tooth infections can also contribute to sinus pain and symptoms.
What Can I Do To Help Myself Recover
Your recovery time after sinus surgery depends on your personal health and the type of procedure you have. Your surgeon will tell you what to expect. But you may need to stay home from work for at least a week after your surgery. This may feel overwhelming, but the good news is, there are things you can do to help your recovery after sinus surgery:
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Attend follow-up visits with your surgical team. After surgery, its important to follow up with your provider as instructed. At these visits, your provider will clean out blood and fluid from your nose and sinuses. These visits are important to make sure you are recovering well and to help your sinuses heal.
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Flush your sinuses. You will be instructed to flush out your sinuses after surgery at least twice a day. Nasal irrigation devices, such as neti pots and squeeze bottles, help to clear debris and mucus. Its best to follow these instructions in order to heal quickly.
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Do not smoke. Smoking interferes with the healing process and can result in failure of the surgery.
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Avoid straining. Try to avoid straining, such as blowing your nose too hard or lifting anything greater than 20 pounds for 1 to 2 weeks. Straining yourself can worsen bleeding.
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Avoid aspirin and NSAIDs. Dont take aspirin or NSAIDs for 1 to 2 weeks after surgery because these can worsen bleeding.
If you have questions about your instructions, or if you have unexpected discomfort, please contact your surgical team.
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Why Use An Anti
For years, the go-to choice for allergy relief was an antihistamine, usually in the form of a pill. But antihistamines only block histamine, just one of the many allergic substances your immune system releases when youre exposed to an allergen.*ii
An OTC allergy spray thats formulated with corticosteroidsa type of medicine approved by the FDA to treat nasal allergy symptomsprovides more complete relief of total nasal symptoms than an antihistamine.iii
Nasal sprays with corticosteroids block a variety of allergic substances. For example, FLONASE helps block six key allergic substances, including histamine, to treat your symptoms.*
Home Remedies For Sinus Infection:
Uncomplicated acute sinus infection can be treated at home. Or home remedies can also be used along with conventional medical therapy.
Rest Take adequate rest as your body is already working enough to fight infection. Another reason to get good rest is so that you dont spread the infection at your workplace, school or institution.
Water Drink plenty to water to not just stay hydrated but water also helps to flush out toxins from the body making recovery easier.
Steam Inhaling steam decongests your air passages allowing the sinuses to drain easily.
Essential Oil Menthol is a well-known essential oil for blocked sinuses. It can be used along with steam to inhale.
Kitchen Herbs Our kitchen itself can provide the best of natural remedies to fight infections. You can use natural anti-infective and anti-inflammatory herbs like turmeric, ginger, and garlic.
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When Should I Go See The Doctor About A Sinus Infection
It is pretty easy to care for most sinus conditions on your own. However, if you continue to have symptoms that concern you or if your infections continue to happen, your primary care doctor might suggest you see a specialist. This could also happen if your CT scan shows something that does not look right.
A note from Cleveland Clinic
Sinusitis, or swelling of the tissues of the sinus cavities, is a common condition with many causes, including viruses and bacteria, nasal polyps or allergies. Signs and symptoms may including facial pressure, fever and tiredness. You can treat symptoms at home by resting, taking over-the-counter products and increasing your fluid intake. Make sure you contact your healthcare provider if symptoms do not improve, if sinusitis happens often or if you have any symptom that worries you.
Last reviewed by a Cleveland Clinic medical professional on 06/04/2020.
References
Do I Need Antibiotics For Every Sinus Infection
Many sinus infections are caused by viruses, the ones that cause the common cold. These types of infections are not cured by antibiotics. Taking an antibiotic for a viral infection unnecessarily puts you at risk for side effects related to the antibiotic. In addition, the overuse of antibiotics can lead to antibiotic resistance, which may make future infections more difficult to treat.
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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.