Caveats: Refer Seriously Ill Patients And Complicated Cases
A very important caveat to our recommendation is that seriously ill patients must be managed differently. Very infrequently a patient develops a serious complication of acute sinusitis such as brain abscess, periorbital cellulitis, or meningitis. Therefore, seriously ill patients with signs and symptoms of acute bacterial sinusitis, such as high fever, periorbital erythema or edema, severe headache, or intense facial pain must be carefully evaluated and treated with great caution and close follow-up. These patients should be referred immediately for consultation with an otolaryngologist.
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.
Is Your Sinus Infection Caused By A Virus Or Bacteria
Physicians may not know if sinusitis is bacterial or viral, because the diagnosis is typically done by observing symptoms. Symptoms include:
- Nasal congestion
- Thick nasal or post-nasal drainage
Sometimes other tests such as computed tomography scan or cultures are used to help make the diagnosis.
Despite the recommendations that antibiotic use be judicious, they are still overused for sinusitis, according to many physicians who specialize in treating sinus problems.
Some physicians say they give patients with sinusitis a prescription for antibiotics, and recommend they wait three to five days before filling it, and only fill it if symptoms are not better by then. A can be used to help relieve your symptoms and promote drainage.
The longer symptoms last, the more likely a sinus problem is to be a bacterial infection, some experts say.
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When To Consider Antibiotics For Sinus Infections
AAAAI advises that antibiotics for sinus infections should be considered only if you develop a fever of 102° F or higher, you have severe face pain and tenderness, your symptoms last longer than a week or so, or your symptoms improve and then worsen again.
Some patients with acute sinusitis do need antibiotics, and if they continue with a worsening infection without treatment, they can suffer dramatic complications such as loss of vision, meningitis, or brain abscess, Patel says.
If your doctor says you need an antibiotic, ask for generic amoxicillin/clavulanate, according to guidelines from UpToDate, which provides evidence-based treatment information to healthcare providers. Its usually the best choice and works as well as more expensive brand-name antibiotics.
Avoid taking fluoroquinolones, a group of antibiotics that includes ciprofloxacin and levofloxacin . Although widely used, the antibiotics are inappropriate for treating sinus infections and they pose serious risks.
In 2016, after a safety review, the Food and Drug Administration linked fluoroquinolones to disabling and potentially permanent side effects. The agency advised against using the drugs to treat common illnessesbronchitis, sinus infections, and urinary tract infections.
How Long Does A Sinus Infection Last
Sinus infections can last several days. Viral sinus infections are usually most severe three to six days after they start, and then begin to improve by day 10. A viral sinus infection can develop into a bacterial infection, which typically lasts longer than 10 days. Patients will usually respond to antibiotics within two to three days after a bacterial sinus infection is diagnosed and treated. After that, sinus infections can resolve anywhere between seven and 14 days.
There are three types of sinusitis. All three are based on length of symptoms:
- Acute Sinusitis – symptoms last for less than four weeks
- Subacute Sinusitis – symptoms last for four to 12 weeks
- Chronic Sinusitis – symptoms last for more than 12 weeks
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When Does Antibiotic Resistance Occur
Antibiotic resistance occurs in a persons own body and within the community when certain drugs no longer work for a specific type of germ. This can occur when bacteria change in response to exposure to antibiotics so that the antibiotics no longer work efficiently against the bacteria.
Unfortunately, it’s hard to know if a sinus infection is bacterial, viral, or has other causes based on symptoms alone. Because viral sinus infections tend to improve in 5 to 7 days, healthcare providers will usually only prescribe antibiotics if your symptoms go on for longer than this. A sinus infection that persists for longer than a week or continues to get worse during this time period is more likely to be bacterial.
Therefore, allergists and other specialists recommend limiting the use of antibiotics unless:
- Symptoms last over seven to 10 days
- A fever is present
When To Use Antibiotics To Treat A Sinus Infection
Antibiotics only work against bacterial infections, so the best time to use them for a sinus infection is when you and your doctor suspect bacteria caused the infection.
Otherwise, you may be at risk for unwanted side effects or even antibiotic resistance.
When this happens, bacteria outsmart the medications designed to kill them, and the antibiotics no longer work when you need them.
That said, it can be hard to know whether a sinus infection is viral or bacterial.
Some scenarios, such as an infection that persists longer than 10 days or an infection that goes away and then returns, may indicate a bacterial infection and prompt a provider to prescribe antibiotics.
In some cases, a healthcare provider may also treat a sinus infection with antibiotics as a precaution to prevent complications in people with compromised immune systems that cant easily fight off infections.
If your doctor prescribes antibiotic treatment, follow their instructions.
Take the antibiotics at the same time every day. If you miss a dose, take it when you remember or, if its close to your next dose, wait until then and take one dose.
Do not double up on antibiotics doses.
If you experience unwanted side effects of antibiotics, your sinus infection isnt improving, or you develop new symptoms, contact your healthcare provider, who can help you figure out whats going on.
While sinus infections usually dont cause major medical problems, they can have severe symptoms and other complications.
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Do Antibiotics Treat Sinus Infections
Antibiotics are a type of medication that stops bacteria from growing and, as a result, improves symptoms of an infection.
Healthcare providers only prescribe antibiotics for sinus infections that they believe are bacterial.
Antibiotics dont work on viral or fungal infections, and taking antibiotics when you dont need them can cause unnecessary side effects such as diarrhea, nausea, and stomach pain.
Plus, taking antibiotics too often can create antibiotic resistance.
The most common antibiotics prescribed for sinus infections are penicillin-class antibiotics such as amoxicillin or amoxicillin-clavulanate .
If you have a penicillin allergy, a common alternative is doxycycline.
Using The Right Water During Saline Rinses
When using saline nasal rinses, tap water should always be boiled and then allowed to cool to ensure cleanliness distilled water or premixed solutions could also be used instead of regular tap water.
Other home remedies for sinus infections include:
- Drinking fluids: Drinking lots of fluids helps loosen and thin mucus. Avoid beverages that are caffeinated and alcoholic beverages that can dehydrate the body, which could thicken mucus.
- Breathing steam: Warm water is best . You can breathe in steam from either a bowl or shower.
- Humidifying the air: Use a cool air vaporizer or humidifier,particularly at night while sleeping.
- Avoiding environmental substances: Avoid tobacco smoke and chlorinated water that can dry up the mucus membranes and exacerbate symptoms.
- Implementing treatment measures: At the first sign of infection, use antihistamines and employ regular nasal rinses.
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Most Sinus Infections Dont Require Antibiotics
Ah, sinus infections. The New England Journal of Medicine published a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.
It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, theres the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
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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Why Might Your Doctor Recommend Antibiotics For Sinusitis
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.
- Your symptoms are severe, or you have other problems, such as pus forming in your sinus cavities.
- You have had sinusitis for 12 weeks or longer .
What Else Do You Need To Make Your Decision
Check the facts
- You are right. Most of the time, sinusitis is caused by a virus, and antibiotics don’t work against a virus.
- Sorry, that’s not right. Most of the time, sinusitis is caused by a virus, and antibiotics don’t work against a virus.
- It may help to go back and read “Get the Facts.” Most of the time, sinusitis is caused by a virus, and antibiotics don’t work against a virus.
- Sorry, that’s not right. Taking antibiotics too often or when you don’t need them can be harmful. The medicine may not work the next time you take it when you really do need it.
- You’re right. Taking antibiotics too often or when you don’t need them can be harmful. The medicine may not work the next time you take it when you really do need it.
- It may help to go back and read “Get the Facts.” Taking antibiotics too often or when you don’t need them can be harmful. The medicine may not work the next time you take it when you really do need it.
- You’re right. Antibiotics can treat short-term sinusitis when it is caused by bacteria. But many people get better even without antibiotics.
- Sorry, that’s not right. Antibiotics can treat short-term sinusitis when it is caused by bacteria. But many people get better even without antibiotics.
- It may help to go back and read “Get the Facts.” Antibiotics can treat short-term sinusitis when it is caused by bacteria. But many people get better even without antibiotics.
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Risk Of Unnecessary Antibiotics For Sinus Infections
Taking unnecessary antibiotics for a sinus infection is not only ineffectual, but can actually be harmful to the patient. Risks of taking unneeded antibiotics include:
- Increased chance of getting an antibiotic-resistant infection at a later time
- Destruction of healthy stomach bacteria, which can allow harmful bacteria to grow
- Possible side effects, such as upset stomach, rash, or dizziness
- Allergic reaction
According to studies conducted by the American Academy of Allergy, Asthma, and Immunology , 60-70% of patients with sinus infections fully recover without the use of antibiotics. Additional research shows that almost 90% of U.S. adults diagnosed with acute sinusitis are prescribed antibiotics.
This overuse of antibiotics for sinus infections, as well as other conditions, can lead to antibiotic resistance, a state in which bacteria change over time as a reaction to antibiotic treatment, in order to survive and multiply, thus making the antibiotics less effective.
Antibiotics Should Not Be Used To Treat The Majority Of Sinus Infections Nice Says
NICE is advising healthcare professionals to tell their patients that a sinus infection will likely clear-up without antibiotics and that there is little evidence oral decongestants will help to relieve their symptoms.
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.
Inappropriate use of antibiotics, such as taking them for viral conditions is known to fuel resistance. Despite this, data has shown antibiotics are given to 91% of people who visit their GP with symptoms of sinusitis.
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When To Seek Medical Care
See a doctor if you have:
- Severe symptoms, such as severe headache or facial pain.
- Symptoms that get worse after improving.
- Symptoms lasting more than 10 days without getting better.
- Fever longer than 3-4 days.
You should also seek medical care if you have had multiple sinus infections in the past year.
This list is not all-inclusive. Please see a doctor for any symptom that is severe or concerning.
Other conditions can cause symptoms similar to a sinus infection, including:
- Seasonal allergies
Personal Stories About Antibiotics For Sinusitis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I’ve had sinusitis a few times. So when my doctor suggested I take an antibiotic, I asked him if I really needed it. He said I would probably get better faster if I took the medicine. But I know from the other times that I’ll probably be okay in a week or so anyway. So we decided to wait and see instead of trying antibiotics.
I can’t wait to feel better. It seems like I’ve had bad sinus pain for the longest time. It’s been at least 2 weeks. Nasal sprays aren’t helping. I’m going to ask my doctor for antibiotics.
I thought I just had a bad cold, but my doctor says I have sinusitis caused by a bacterial infection. I’ve been doing all the right things at home, but it isn’t going away. I think antibiotics are the next step for me.
I thought I’d get my doctor to give me some antibiotics for my sinusitis. Then I’d be over it sooner. But it turns out that antibiotics won’t help me, since my sinusitis started as a cold. I didn’t know that antibiotics don’t always work. I’m going to wait it out instead.
John, age 52
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How Is Sinusitis Treated
Your treatment will depend on the cause of your sinusitis. Most of the time, treatment includes medicines and taking care of yourself at home. Medicines that are used most often include:
- , such as Sudafed, that are taken as pills or liquids. These can reduce swelling and improve sinus drainage.
- Over-the-counter pain medicine, such acetaminophen or ibuprofen .
- Antibiotics, which kill bacteria. Antibiotics will only work if your sinusitis is caused by bacteria. Most of the time, sinusitis is caused by a virus.
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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