When To Take Antibioticsand When Other Treatments May Work Better
If youve been knocked out by sinus infection symptomsstuffiness, face pain or pressure, nasal dischargeyour doctor might recommend that you wait it out for a week or so before resorting to an antibiotic. And she or he might be right: Antibiotics are often not necessary for clearing up a sinus infection, according to recent research.
As a result, many health experts, including Zara Patel, M.D., a sinus infection expert and assistant professor of otolaryngology at Stanford University in Stanford, Calif., are urging doctors to think twice before prescribing antibiotics for sinus and other respiratory infections.
A 2016 study, published in JAMA, found that people who went to the doctor with a sinus infection were more likely to leave with a prescription for antibiotics than people seeing the doctor for any other reason . But some doctors, pointing to newer evidence, are starting to take a more cautious approach.
For acute sinusitis, there are very well-done studies indicating that antibiotics are not necessary in the vast majority of patients, and most people will be able to clear an infection on their own, Patel says.
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.
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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Sinus Infection Treatment At Home
It isnt possible for you to tell at home if sinusitis is caused by a bacteria, virus or fungus, but there are some steps you can take to help relieve sinus infections symptoms. They include:
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Moisturizing the room air with a humidifier or vaporizer
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Increasing your fluid intake to ensure you are well hydrated
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Using saline sprays or nasal irrigations
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Using nasal spray decongestants for 2 or 3 days at the most
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Applying warm compresses to your face to help relieve pain and pressure
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Sleeping with your head elevated. If sleeping on a pile of pillows isnt comfortable, place blocks under the two legs at the head of your bed to elevate it.
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Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen
Ways To Recognize Serious Signs Of Sinus Infections
#1: Duration
The length of the infection is an important determinant of the seriousness of the infection.
I usually consider most infections less than 3 weeks to be viral or inflammation related to congestion. At this point, the best treatment is usually medications that decrease the congestion and inflammation. This in turn will alleviate the symptoms and ultimately cure the illness.
When the illness continues beyond 3 weeks, bacterial infection can begin to develop. Though antibiotics can be considered at this point, other treatments may still be the best answer if they have not yet been given a try.
#2: Mucous Color
I will dispel a myth right here and now. Yellowish/greenish mucous does not necessarily mean the infection is bacterial.
Viruses can cause the same color mucous. The reason for the mucous is generally not the actual bacteria or virus, but the bodys immune response to the intruder.
So dont worry just because you see a colored mucous when you blow your nose. This will also improve as the infection abates.
#3: Sinus Pain
Sinus pain can occur anytime throughout a sinus infection. This is normal and means there is inflammation in the sinuses, as we discussed previously.
However, severe pain, redness over the skin, hardened skin over the sinuses, or even a severe headache are not generally normal and can indicate a bacterial infection.
#4: Fever
A fever can be caused by both viruses and bacteria. So how do you differentiate between the two?
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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
- Antihistamines
- 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.
Nice Is Advising Healthcare Professionals To Tell Their Patients That A Sinus Infection Will Likely Clear
27 October 2017
The final guidance, developed with Public Health England, makes recommendations for treating acute sinusitis.
In most cases, people who have sinusitis will start to feel better within two-to-three weeks. The infection is usually viral, which means antibiotics should not be routinely prescribed, the guidance says.
Instead, NICE says healthcare professionals should advise their patients on how to manage their aches and pains with paracetamol.
They should also tell them that there is no evidence oral decongestants or steam inhalation will make any difference. And inform them that they should seek further medical advice if their symptoms get worse, or last for more than three weeks.
Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, said: We know that most people with sinus infections will recover in a couple of weeks without needing any antibiotics, but that doesnt mean we should be sending them home without any information or advice.
Health professionals can help their patients cope with this infection and the sometimes unpleasant symptoms it can cause. They should tell them that theyll probably be feeling this way for a while, and that unless they are very unwell, the best thing to do is to take paracetamol and take it easy.
Professor Gillian Leng, deputy chief executive at NICE said:Antibiotic resistance is one of the greatest dangers to our health, which is why we must all work together to fight it.
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Causes & Risk Factors
Any health situation that blocks off the vital drainage channels of your sinuses can cause a sinus infection including:
- Respiratory infections like the common cold
- Hay fever or exposure to allergens such as cigarette smoke, dry air and pollutants
- Obstructions in the nasal or sinus cavities including nasal polyps, deviated septum, or nasal bone spur
- Non-allergic rhinitis
- Changes in air pressure
- Infections resulting from dental problems
- Physical injury to the sinuses
- Bacteria, viruses, and fungi
The five most common bacteria that can cause sinus infections are: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes.
Risk factors for sinus infections include:
- Having asthma
- Being in the hospital, especially if the reason you are in the hospital is related to a head injury or you needed a tube inserted into your nose
When To See A Doctor For Asinus Infection
often goes away on its own however, there are times when you should see your doctor for sinus infection treatment if self-care doesnt work. You should see a doctor if you still have sinusitis symptoms after a week or if they return more than a few times within a year. You should also see a doctor as soon as possible if the infection worsens. Signs of a worsening sinus infection include:
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Recommended Dosage Of Prednisone
Your doctor will likely recommend that you inhale the steroid through the nose. Inhaling steroids delivers the steroids directly to the inflamed parts of your tissues. But if you have polyps in your nose, they may block your nasal passages and stop the steroid from reaching the inflamed areas. If inhaled steroids prove not to be effective in giving you desired results, a your doctor may consider giving you a short course of oral Prednisone. Taking Prednisone for about a week is enough to reduce the size of polyps and reduce overall nose inflammation. Since inflammation is reduced and polyps shrink in size, inhaled steroids can reach their target easily and deliver the best results. Patients are most commonly prescribed 60mg of Prednisone per day, but the dosage may vary, depending on the condition of the patient and their individual response to the drug.
Most doctors avoid using oral steroids, this is likely because these steroids travel into the patients blood stream and in turn one’s entire body becomes exposed to the medicine. On the contrary, topical and inhaled steroids are only exposed to the sinuses and nose. Patients taking oral steroids are more susceptible to developing side effects. These side effects may include mood swings, increased blood pressure and glaucoma. However, no serious side effects should occur as long as Prednisone is taken in low dosage for a short period of time, supervised by a medical professional.
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.
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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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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:
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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.
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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Will My Sinus Infection Clear Up On Its Own
The first few weeks of the common cold arent fun, but the acute sinusitis that can pop up afterwards doesnt help either. Sinus congestion and the common cold, unfortunately, go hand in hand. Acute sinusitis frequently is caused by the common cold, but also can be caused by allergies and bacterial and fungal infections.
Sinus infections are caused when the cavities around your nasal passages become inflamed and swollen, which eventually interferes with drainage and causes mucus to build up. This tends to get annoying, because it makes breathing through the nose difficult. It also affects the area around your eyes and face, and can cause a throbbing headache.
When a sinus infection hits, its always 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 arent recommended within the first week of developing a cold. About 70 percent of sinus infections go away within two weeks without antibiotics.
Consider these other forms of treatments instead of antibiotics:
- 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. They can help to prevent and treat inflammation.
Antibiotics only will be needed if the infection is severe, recurrent or persistent.
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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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