Over the past month my daughter, my aunt, my father-in-law and sister-in-law all have been taking antibiotics for a sinus or an upper respiratory infection. As the infectious disease doctor in the family, I feel partly responsible for all this.
For my teenage daughter it started with a simple cold and runny nose, which she could not shake off. Then she developed a slight cough, a low-grade fever, morning congestion, facial pain, pressure and fullness. For a week she trudged to school taking Dayquil before leaving and after coming back. At night she put on Vick’s vapor rub. Her grandmother gave her Indian herbal therapy too, but the congestion and the gunk would not go away.
One morning at the kitchen counter, as my daughter ducked her head under a towel over a steaming pot to take in some warm moist air, my wife confronted me, making me feel guilty about our daughter’s lack of recovery. “When are you going to start an antibiotic?” she demanded. Mind you there is no easy answer.
Sinusitis, an inflammation of the multiple airspaces in the face, can be caused by viruses or bacteria and occurs over weeks and months. It’s important to get the diagnosis right to tailor the treatment.
In fact, data shows that sinusitis is one of the most frequently mistreated illnesses. Up to 20 percent of all antibiotics prescribed are for sinus infections and a majority of these antibiotic treatments may be unnecessary, according to a national campaign, “Choosing Wisely.” Overuse of antibiotics is a big public health concern because bacteria are becoming antibiotic-resistant, making infections more dangerous and difficult to treat.
So when do you need an antibiotic for a sinus infection?
First, the doctor needs to differentiate between an acute viral sinusitis (similar to a common cold) and an acute bacterial sinusitis. Viral sinus infections usually last less than 10 days, and are mild in nature.
Bacterial sinus infections persist for over two weeks or can present as “double worsening.” That is, initially the patient feels better, which likely means the viral infection is improving, but then she begins to feel worse, which is the bacterial infection coming on. What is happening is that the viral infection causes swelling and mucous and gunk in one’s nose, setting the stage for a super-imposed bacterial infection. Less than 2 percent of viral infections convert to bacterial infections.
Another sign of bacterial sinus infection is high fever over two or three days with runny nose with pus, sinus congestion and severe pain. It is important to know that acute bacterial sinusitis requires antibiotics, and viral sinusitis does not.
Chronic sinusitis has varying symptoms and requires a different treatment. This is what happened in my aunt’s case. She had sinus congestion for over two months with drainage containing pus, and she was not improving even after several courses of antibiotics. A CT scan showed that her left sinus was completely blocked up and ultimately required sinus drainage by an ear, nose and throat doctor.
So my advice to family and friends is the same:
Let’s find out where the infection is in the spectrum of illness: acute or chronic, viral or bacterial.
Try to avoid antibiotics initially and treat acute sinusitis for the first two weeks.
Get rest to let the body fight an infection,
Drink warm fluids to help thin nasal congestion and loosen phlegm.
Boost humidity with warm moist air in the shower.
Gargle with a half-teaspoon of salt in warm water to soothe the throat, rinse the nose with salt water sprays or nasal irrigations to clear secretions and take over-the-counter treatments for decongestion and symptom relief.
On the 14th day of my daughter’s sinus symptoms I told my wife, “Now we start antibiotics.” And within three days my daughter was symptom free.
By the way, as for my cold and sinus congestion that I wrote about a few weeks ago, it got better after a week, without any antibiotics.
Source : Commercial Appeal