Why antibiotics may not help most sinus infections

April 11, 2012

Allergy medication

Ask any scientist to list history's greatest discoveries, and he or she will likely include antibiotics. Antibiotics are medicines made from certain bacteria, fungi or other organisms that can kill or weaken other organisms that attack our bodies. Penicillin is the first and most well known antibiotic. Since its discovery, countless lives have been spared from diseases that used to be killers.

For a time, antibiotics were thought to cure almost everything, even cancer. While it would be great, we now know this isn't true. And we're learning more every day. Like this: A new study says that antibiotics may not cure most sinus infections.

What is sinusitis?

It's often called a "sinus infection," and it means there's inflammation or swelling in one or more of a person's sinuses. Sinuses are small spaces in the forehead and cheekbones. They're filled with air, and their job is to make mucus. When we're healthy, this mucus drains into our noses. When our sinuses are inflamed, the drainage stops and the misery starts. Then we have sinusitis – an infection of our sinuses.

Many things can cause sinusitis. That's why one thing may not be enough to treat it. Allergies, pollen, bacteria, pollution, dust, viruses – the list of what can irritate our sinuses and set off an infection goes on and on.

Signs of sinusitis include:

  • Headaches
  • Nasal congestion
  • Runny nose/nasal discharge
  • Postnasal drip (mucus drips down the throat from the nose)
  • Sore throat
  • Fever
  • Cough
  • Fatigue
  • Bad breath

Sinusitis is so common in the United States that 1 of every 5 antibiotic prescriptions written is to treat it. But it looks like those prescriptions may not be the right answer in many cases.

Bacteria and viruses: two different things

There are two "usual suspects" doctors turn to first when dealing with an illness. The first group is bacteria. The second is viruses. Bacteria and viruses aren't the same things. So, bacterial infections and viral infections aren't the same, either.

Unfortunately, antibiotics don't work on a viral infection. That's why doctors don't always give us prescriptions for antibiotics: sometimes we have something viral.

Now, researchers are finding that sinus infections can be either bacterial or viral.

And lately, more scientists seem to be thinking that viruses are to blame for most sinus infections.

A new medical study: antibiotics don't work on sinus infections

The most conclusive study so far was published in the February 15, 2012 issue of The Journal of the American Medical Association. It's by the Washington University School of Medicine in St. Louis and covered 166 adults with sinus infections. Over 10 days, one group of patients was treated with amoxicillin, a popular antibiotic. The other was treated with a placebo, which is a "fake" pill sometimes called a sugar pill. If they needed it, both groups also got over-the-counter remedies for their symptoms – headache, stuffy nose and sinuses, coughs, fever, etc.

At the end of the 10 days, it was clear that patients taking amoxicillin didn't feel better sooner, or recover any faster, than those who were getting the placebo.

Dr. Jane M. Garbutt, the study's lead author, said, "We hope this study provides scientific evidence that doctors can use with patients to explain that an antibiotic is not likely to help an acute sinus infection."

"I think more often than not, these infections are viral, so antibiotics aren't going to help," Garbutt said. While some sinus infections may actually come from bacteria, she said, it's hard to tell a bacterial infection from a viral one. Basically, the only way to know is to draw a sample from a person's sinus, and that would take surgery.

The United States Centers for Disease Control and Prevention (CDC) agrees. The CDC's website says viral sinusitis often occurs after a cold (which is a virus) and usually lasts for less than four weeks. Bacterial sinusitis can cause symptoms for up to 12 weeks.

No matter which kind you may have, a growing number of experts think it's best to watch and wait.

Why not take antibiotics just in case?

Besides the fact that taking antibiotics for sinusitis means spending money on medicine that may not help you, more and more studies say you could be risking your future health. Why?

It appears that more and more kinds of bacteria aren't being killed by antibiotics anymore. In medical terms, they're becoming "resistant" to the drugs.

Each time you take an antibiotic, the bacteria that usually live in your body are more likely to become resistant to antibiotics. In time, common antibiotics can't kill infections caused by these resistant germs.

The CDC is very concerned about resistance to antibiotics. From a public-health point of view, resistance could be a disaster. Overuse of antibiotics has already led to the rise of drug-resistant infections like MRSA (Methicillin-Resistant Staphylococcus Aureus). Fighting MRSA is creating a lot more work at hospitals these days.

So while sinus infections make us feel terrible, if we were to build resistance to antibiotics by over-using them to treat sinus infections, what might happen if we're faced with a bacteria-caused epidemic and no one responds to the drugs?

If you'd like to learn more about this very important issue, the CDC offers an excellent series of questions and answers about antibiotic resistance here. It really is something we all need to think about.

Researchers know people aren't going to like this "wait and see" approach to such a "nasty disease," as Garbutt describes it. She said: "People have significant symptoms. They feel miserable and miss time from work. If an antibiotic is not going to be of any benefit, then what is? That's a question we haven't answered yet. But we are working on it."

Bottom line?

The CDC says a doctor should never give an antibiotic until symptoms have gone on for at least seven days. In light of this new research, your doctor may want to wait even longer before writing a prescription. Even though it may not be what you want, if your doctor wants to wait, he or she is doing it for your long-term health. Besides: if your sinusitis is viral, an antibiotic won't help anyway.

Other options for relief

Some people say they feel less congested when they drink hot fluids. Others find some relief from warm, wet compresses on their faces. Still others use warm-water vaporizers. Decongestant nasal sprays can help, though no one should use them for more than a few days. It's too easy to become dependent on them.

Several safe and "more-natural" options are out there, and many people report good results with them. One choice is a saline (salt) nasal spray. Another is a "neti pot." A neti pot looks like a little teapot. Its spout is used to gently pour warm saline solution – a mix of salt and water – into the nostrils. Neti pots, saline sprays, and their cousins, the more-powerful saline nasal rinses can help flush mucus out of sinuses. Clearing mucus, especially infected mucus, out of clogged sinuses brings great relief.

Over-the-counter medicines like ibuprofen can help ease sinus swelling and the face pain it brings. But doctors say you should also try to clear your nasal passages, because it will help ease symptoms and clear the infection.

When to see a doctor

The CDC recommends you see a doctor or healthcare provider if you have:

  • A temperature of more than 100.4° F.
  • Symptoms that last more than 10 days.
  • Multiple episodes of sinusitis in a year.
  • Symptoms that over-the-counter medicines can't ease.

If your child is younger than three months of age and has a fever, always call your healthcare provider right away.

The CDC's Top 5 ways to avoid a sinus infection

  1. Keep your hands clean – regular hand washing is still the best way to fight disease.
  2. Keep yourself and your family up to date with recommended immunizations.
  3. Avoid close contact with people who have colds or other upper respiratory infections.
  4. Avoid smoking or being exposed to second-hand smoke, and don't expose children to second hand-smoke.
  5. Use a clean humidifier to moisten the air at home.
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