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Sinus Problems: Do Antibiotics Help or Hurt?

Patients with painful sinus problems often plead with their doctors to give them an antibiotic ASAP.

About 90% of adults seen in the U.S. by a general practice physician do end up getting an antibiotic for acute sinusitis, research has found.

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Acute sinusitis is a sinus infection that lasts less than four weeks. Chronic sinusitis lasts longer than 12 weeks. Infections of the sinuses, hollow air spaces within the bones in the cheek bones, forehead and between the eyes, are usually caused by viral or bacterial infections. They cause thick mucus blockage and discomfort of theses cavities.

But antibiotics may not always be the best remedy for sinusitis, according to recent research and physician experts. Your body should be able to cure itself of a mild or moderate sinusitis and avoid antibiotics that can cause antibiotic resistance.

Judicious use of antibiotics is now recommended by many agencies that have published guidelines, including practice guidelines issued jointly by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

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 be 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.

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
  • Pain or discomfort around the eyes, forehead or cheeks
  • Cough
  • Headache
  • Thick nasal or post-nasal drainage

Sometimes other tests such as computed tomography (CT) 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 decongestant 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. Clear white mucus often accompanies a viral sinus problem, and yellow or green mucus more likely indicates a bacterial sinus infection.

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