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Should you treat a sinus infection with antibiotics?

Over the past few months I’ve 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 patient’s sickness.

If sinus issues are present for one week, they are more than likely linked to a virus like the common cold — that’s the case for nine out of 10 adults. Viral infections like these do not require antibiotics, and you may not need any prescribed medication at all. In fact, U.S. health care providers often prescribe patients too many antibiotics. A recent study published in Infection Control & Hospital Epidemiology found inappropriate levels of antibiotics were prescribed for viral infections, concerning experts. Too many antibiotics, and the bacteria sometimes begins to outsmart our medications, leading to antibiotic resistance.

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 professional’s 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.

There are some medications that are not antibiotics that I prescribe to help relieve symptoms for viruses like the common cold and symptoms from allergies. One patient I recently saw in clinic complained of a constant headache and ear pain. After looking in her ears, nose, throat, and then pressing on her sinuses, it was clear that her symptoms were likely from sinus congestion caused by allergies. A go-to medication that I suggested to her that is supported by the American Academy of Otolaryngology- Head and Neck Surgery was Flonase, a nasal steroid. Nasal steroids like Flonase and Nasacort can be used for viral and allergic sinus issues for as many as 21 days to help decrease nasal congestion.

I’ve seen my patients commit common mistakes when they try to treat sinusitis on their own. For example, taking antihistamines, such as Zyrtec or Benadryl, for sinus problems thinking their symptoms are from allergies, but later realize they feel worse. These medications cause drying of the nose and thick mucus build-up leading to more sinus congestion. One of my patients was amazed that this exact thing happened to her and was thankful when her symptoms improved after she stopped taking the antihistamines. Also, some of my patients spray nasal decongestants, like Afrin. But if used for more than three days, these over-the-counter medicines can cause more sinus swelling. Viral sinusitis should resolve in less than 10 days. But if the sickness is linked to allergies or bacterial infection, symptoms can last longer.

Bacterial infections can be trickier. Patients do need antibiotics when it’s a bacteria that is making them feel sick. These can reduce symptoms and help them get better, faster. Bacterial sinusitis is more likely when symptoms last more than 10 days. If symptoms seem to have improved only to come back as more aggressive, a bacteria may also be the source. In both of these cases, antibiotics may be needed to help you feel better. Patients can take antibiotics for five to 10 days, sometimes longer. A person with bacterial sinusitis typically shows improvement in the first seven days of treatment.

For my patients, I suggest these home remedies, no matter the source of the sinusitis: ample rest, hydration and using devices like the humidifier or nasal rinses. These treatments thin mucus within the sinuses, leading to less sinus congestion (and happier, healthier patients). Avoiding cigarette smoke can also be helpful in improving symptoms.

If you’re still concerned about your symptoms, tell your health professional, and if they don’t improve, schedule a follow-up visit. Sinusitis is common, but there is always a chance that something else may be going on, warranting further evaluation and possibly more treatments.

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