Monday, June 17, 2024

Antibiotic Of Choice For Sinus Infection

What Respiratory Tract Illnesses Need Antibiotics

Treating sinusitis | Consumer Reports

While sinusitis rarely requires antibiotic treatment, there are some respiratory diseases that warrant use of antibiotics more often.

Pneumonia is one of them. Especially for young children and older people, pneumonia can potentially be life-threatening. Typical symptoms are cough, chest pain, high fever, breathing difficulties and generalized weakness. In particular, if you are suffering from shortness of breath, you should seek prompt medical attention.

Strep Throat is another respiratory illness caused by bacteria that sometimes requires the use of antibiotics. Its symptoms include a severe sore throat that is accompanied by high fever and swollen infected lymph nodes below your jaw on both sides of your neck. Swollen tonsils with white spots is another symptom. Strep throat does nnot cause a coughing or a runny nose. If you suffer from the latter two, its most likely not strep throat.

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:

  • You have symptoms of a bacterial infection and you have not gotten better after 10 days, even with home treatment.
  • You have severe symptoms such as severe headache or facial pain, or you have other problems, such as pus forming in your sinus cavities.
  • You have had sinusitis for 12 weeks or longer .
  • You have a fever longer than 3-4 days.
  • Your symptoms get worse after initially improving.
  • 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.

    Important Factors To Keep In Mind

    • Avoid drinking alcohol and caffeinated drinks while you are on prescribed antibiotics or any sort of medicine, as alcohol intake reduces its effectiveness which makes the entire course useless.
    • While other medicines are available over-the-counter, it is much better to ask your doctor first if you have certain allergies or condition. This is to avoid unpleasant reactions because a medicines effectiveness also depends on the individuals health.
    • For a maximum result, never miss your dose on a given time. Make sure you check the labels and that you fully understand the instructions, particularly on the amount of dose that you are supposed to take.
    • If you suddenly feel that theres something wrong in your body after taking your meds, observe how it affects you. If you show severe symptoms that you are not familiar with, do not hesitate to consult your doctor.
    • Some antibiotics or medicines are not to be taken by pregnant women doctors usually recommend a certain brand for these kinds of patients.
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    For mild cases of ear infection, doctors often recommend watching and waiting before starting use of antibiotics, as many cases will go away on their own. Consult your childs pediatrician before giving any over-the-counter medications to your child.

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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:

  • Keep your sinuses hydrated to help relieve pressure. One good way is to expose your sinuses to steam.
  • Drink plenty of water.
  • Essential oils like eucalyptus and peppermint oils may help open the airways and ease congestion.
  • Apply warm and cold compression alternately to relieve sinus pain and pressure.
  • Eat healthy foods colorful fruits and veggies that boost your immune system. These foods contain lots of vitamin C to fight off viruses.
  • Get plenty of rest for your body to heal and fight the infection.
  • Xvii Which Imaging Technique Is Most Useful For Patients With Severe Abrs Who Are Suspected To Have Suppurative Complications Such As Orbital Or Intracranial Extension Of Infection



    24. In patients with ABRS suspected to have suppurative complications, obtaining axial and coronal views of contrast-enhanced CT rather than MRI is recommended for localization of infection and to guide further treatment .

    Evidence Summary


    The availability of CT and MRI has greatly improved the management and outcome of patients with suspected orbital or intracranial complication of ABRS.


    There are definite risks associated with these procedures. CT scanning results in low levels of radiation exposure, which may lead to radiation-induced illnesses if multiple scans are obtained . With either CT or MRI, there is a potential risk of allergic reactions to the contrast material, and appropriate precaution should be undertaken in patients with renal impairment.

    Other Considerations.


    Because most of our knowledge in this area is based on retrospective case series or reports, the overall quality of evidence is weak. As technology continues to evolve, more studies are needed to clarify the indications of these imaging techniques in the management of ABRS.

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    Other Upper Respiratory Tract Infections

    There are a few other reasons you might be prescribed antibiotics for an upper respiratory infection. Strep throat, medically known as streptococcal pharyngitis, is a sore throat caused by infection by streptococcal bacteria. It is usually treated with penicillin.

    Swelling of the epiglottis, the flap of tissue covering the windpipe, is potentially life-threatening, particularly in children ages 2 to 5 years. Called epiglottitis, this condition can impact breathing and is often caused by infection with the bacteria Haemophilus influenzae type b and should be treated with antibiotics, including a cephalosporin.

    If the cold leads to an ear infection, antibiotics may help resolve it if pain relievers and decongestants dont do the trick. Antibiotic use guidelines for children with ear infections differ based on their age and symptoms.

    Xiii Should Topical Or Oral Decongestants Or Antihistamines Be Used As Adjunctive Therapy In Patients With Abrs


    18. Neither topical nor oral decongestants and/or antihistamines are recommended as adjunctive treatment in patients with ABRS .

    Evidence Summary

    The recommendation against the use of decongestants or antihistamines as adjunctive therapy in ABRS places a relatively high value on avoiding adverse effects from these agents and a relatively low value on the incremental improvement of symptoms. These agents may still provide symptom relief in some patients with acute viral rhinosinusitis when antimicrobial therapy is not indicated.


    Topical and oral decongestants may provide a subjective impression of improving nasal airway patency.


    Topical decongestants may induce rebound congestion and inflammation, and oral antihistamines may induce drowsiness, xerostomia, and other adverse effects. The FDA has recommended that these drugs in over-the-counter products not be used for infants and children < 2 years of age because serious and potentially life-threatening side effects can occur . Caution is advised in children aged 2 years particularly if such over-the-counter medications have multiple active ingredients.

    Other Considerations.


    Topical and oral decongestants and antihistamines should be avoided in patients with ABRS. Instead, symptomatic management should focus on hydration, analgesics, antipyretics, saline irrigation, and INCSs.

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    Ix Should Coverage For S Aureus Be Provided Routinely During Initial Empiric Therapy Of Abrs


    13. Although S. aureus is a potential pathogen in ABRS, based on current data, routine antimicrobial coverage for S. aureus or MRSA during initial empiric therapy of ABRS is not recommended .

    Evidence Summary


    More stringent criteria for establishing a causative role of S. aureus in ABRS will minimize overutilization of antistaphylococcal therapy.


    Obtaining cultures of the middle meatus or sinus aspirates may not be well tolerated in children.

    Other Considerations.


    MRSA is an important pathogen both in the community and the healthcare setting. Accurate diagnosis of MRSA rhinosinusitis with microbiological confirmation is critical for appropriate antimicrobial therapy. More studies are needed to document the utility of endoscopically guided cultures of the middle meatus for distinguishing true infection from contamination by commensal flora.

    Vii Besides A Respiratory Fluoroquinolone Should A Macrolide Tmp/smx Doxycycline Or A Second

    Antibiotic Awareness: Head Cold or Sinusitis


    7. Macrolides are not recommended for empiric therapy due to high rates of resistance among S. pneumoniae .

    8. TMP/SMX is not recommended for empiric therapy due to high rates of resistance among both S. pneumoniae and H. influenzae .

    9. Doxycycline may be used as an alternative regimen to amoxicillin-clavulanate for initial empiric antimicrobial therapy of ABRS in adults because it remains highly active against respiratory pathogens and has excellent PK/PD properties .

    10. Second- and third-generation oral cephalosporins are no longer recommended for empiric monotherapy of ABRS owing to variable rates of resistance among S. pneumoniae. Combination therapy with a third-generation oral cephalosporin plus clindamycin may be used as second-line therapy for children with nontype I penicillin allergy or those from geographic regions with high endemic rates of PNS S. pneumoniae .

    Evidence Summary

    Oral Cephalosporins.

    The respiratory fluoroquinolones are active against both -lactamasepositive and negative respiratory pathogens common in ABRS and can be administered with once- or twice-daily dosing regimens and improved compliance. Doxycycline appears more cost-effective than the respiratory fluoroquinolones. Third-generation oral cephalosporins are well tolerated with minimal adverse effects. However, their coverage for S. pneumoniae is variable.

    Other Considerations.

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    How Often Are Sinus Infection Medications Used

    At least 35 million Americans contract sinusitis each year and are all too familiar with the discomfort associated with sinus infections that require medication.

    If you have a sinus infection and want to know how to get rid of it, or if youre lucky enough not to have one and want to prevent one from happening, there are several measures you can take.

    If youre seeking out sinus infection medication, its important to know the symptoms, causes, and solutions to your discomfort.

    Research Into Antibiotics And Sinus Infections

    The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.

    In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.

    This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.

    Patients who got no treatment were as likely to get better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.

    The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.

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    Get The Best Antibiotics For Sinusitis Infection

    Antibiotics are used to medicate sinus infections, whether acute or chronic sinusitis. The difference is in the dosage. Since acute sinus infections inflict a person for a short period of time only, the antibiotic dosage is commonly just one round of seven days. Dosage for chronic infections may take several weeks, and is likely to repeat throughout the year.

    While you can get some antibiotics over the counter, it is best to get checked up by your doctor first and get a prescription.

    Survey Says

    A survey conducted on the usage of the antibiotics for sinusitis shows that many take antibiotics from the penicillin family. Macrolides and cephalosporins come next.


    If the number of users is an indication, then Amoxicillin is probably the best antibiotics for sinus infection. It belongs to the penicillin family.

    Amoxicillin works by affecting the metabolism of bacteria. It slows it down, alongside increasing the production of your bodys enzymes. Eventually, the bacteria weakens and is killed off.

    Studies peg the effectiveness of Amoxillin in curing sinus infections at almost 89%. This is for acute sinusitis only. Chronic ones may experience different levels of effectiveness.

    Amoxicillin should be taken every 8 hours or 12 hours, at 250 milligrams or 500 milligrams respectively. Children are given less dosage, depending on their weight and age.

    The drug is available in tablet, liquid and chewable tablet forms. It doesnt matter if youve eaten when you take it.

    What Are The Types Of Fungal Sinusitis

    Antibiotic Awareness Week

    Providers classify fungal sinus infections as invasive and noninvasive. Invasive infections can spread to other areas, such as the eyes and brain. Noninvasive sinus infections, the more common type, only affect the nose and sinus areas.

    The types of noninvasive fungal sinusitis are:

    • Allergic fungal rhinosinusitis: This is the most common type of fungal sinus infection. It results from an allergic reaction to fungi inside the nose. Untreated, the sinuses fill up with thick mucus and nasal polyps can form. People with asthma or allergic rhinitis are more likely to develop this condition.
    • Fungal ball : Fungi build up in the sinuses and form a clump or ball. The fungal ball can get bigger and block the sinuses. Providers use surgery to remove fungal balls and clean out the sinuses.
    • Saprophytic fungal sinusitis: This type of infection doesnt actually affect the nose tissue. Instead, fungus grows on crusts of mucus inside the nose. When providers remove the crusts, they remove the fungus, too.

    Untreated, invasive sinus infections are life-threatening. The infection can destroy tissue inside the nose and move into the skull and brain. The types of invasive fungal sinusitis are:

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    How You Can Treat Sinusitis Yourself

    You can often treat mild sinusitis without seeing a GP by:

    • getting plenty of rest
    • taking painkillers, such as paracetamol or ibuprofen
    • avoiding allergic triggers and not smoking
    • cleaning your nose with a salt water solution to ease congestion

    If you have a high temperature or you do not feel well enough to do your normal activities, try to stay at home and avoid contact with other people until you feel better.

  • Boil a pint of water, then leave it to cool.
  • Mix 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda into the water.
  • Wash your hands.
  • Stand over a sink, cup the palm of 1 hand and pour a small amount of the solution into it.
  • Sniff the water into 1 nostril at a time. Breathe through your mouth and allow the water to pour back into the sink. Try not to let the water go down the back of your throat.
  • Repeat the first 5 steps up to 3 times a day until your nose feels more comfortable.
  • You do not need to use all of the solution, but make a fresh solution each time you clean your nose.

    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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    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 youre 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.

    What Are Complications Of Sinus Infection Or Sinusitis

    Treating sinusitis

    While serious complications do not occur frequently, it is possible for a sinus infection to cause a direct extension of infection into the brain through a sinus wall, creating a life-threatening emergency .

    In addition, other adjacent structures can become infected and develop problems, such as osteomyelitis of bones in the skull and infection around the eye . Rarely, these infections may cause death. The most susceptible individuals to complications are patients with suppressed immune systems, diabetes, and relatively rarely from multiple trauma injuries that may occur in natural disasters.

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    Which Antibiotics For Sinus Infection Are Most Effective

    A leading study reflected various efficacies for each antibiotic commonly prescribed:

    90%+ of Amoxicillin, Moxifloxacin & Levofloxacin treatments are effective

    70%-80% of Doxycycline, Azithromycin, Erythromycin, Clarithromycin & Cefprozil treatments are effective

    50-60% of Cefaclor treatments are effective

    80%-90% of High-Dose Amoxicillin, Cefpodoxime Proxetil, Cefixime, and Sulfamethoxazole treatments are effective

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    What Is A Sinus Infection

    The sinuses are cavities in the head that are filled with air. These air-filled pockets are lined with a very thin layer of mucus that functions to collect particles from the air that are breathed in, such as dust, germs, or other particles.

    Very small hair-like projections function to sweep the mucus, along with any particles trapped inside of the mucus. The germ- or dirt-filled mucus then slides down the back of the throat and into the stomach where stomach acid works to kill any germs.

    When a sinus infection occurs, this natural process involving mucus flow is blocked.

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    How Can You Help Your Patient

    What to do, then, for patients with acute sinusitis? Treat the symptoms, which means recommending pain medication for facial pain or headache and saline nasal spray for the nasal discharge, not antibiotics or nasal corticosteroids. Side effects will be fewer and costs will be lower.

    • Saline irrigation. A 2007 Cochrane review of 8 chronic and recurrent sinusitis trials showed that nasal saline irrigation is effective for reducing symptoms of chronic and recurrent sinusitis. Although we do not have high-quality RCT data on saline nasal irrigation for treatment of acute sinusitis, nasal saline irrigation is harmless and inexpensive.

    • What about nasal steroids? The evidence is equivocal, and the most recent high-quality RCT of nasal steroids showed no effect.

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