Experts: Don't treat Sinus Infections With Antibiotics

Most people who have sinus infections should not be treated with antibiotics because the drugs are unlikely to help, according to new guidelines from infectious disease experts.

Although sinus infections are the fifth-leading reason for antibiotic prescriptions, 90 to 98 percent of cases are caused by viruses, which are not affected by antibiotics, according to the guidelines issued today (March 21) by the Infectious Diseases Society of America. Used inappropriately, antibiotics spur the development of drug-resistant superbugs, the IDSA says.

"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,'" said Dr. Anthony Chow, professor emeritus of infectious diseases at the University of British Columbia, Vancouver and chairman of the guidelines panel.

"However, if the infection turns out to be viral — as most are — the antibiotics won't help and in fact can cause harm by increasing antibiotic resistance, exposing patients to drug side effects unnecessarily and adding cost," Chow said.

A study of 166 people with sinus infections published in February in the Journal of the American Medical association showed that those who took antibiotics saw no better improvement in their symptoms than those taking a placebo.

The new guidelines provide specific characteristics of the illness to help doctors distinguish between viral and bacterial sinus infections.

How to tell if it's bacterial
A sinus infection, properly called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose, and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role.

According to the guidelines, a sinus infection is likely caused by bacteria, and should be treated with antibiotics, if any of these criteria are met:

symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days)
symptoms are severe, including fever of 102 degrees Fahrenheit or higher, nasal discharge and facial pain lasting three to four days in a row
symptoms get worse, with new fever, headache or increased nasal discharge

For adults, 5 to 7 days is enough
The guidelines recommend treating bacterial sinus infections with amoxicillin-clavulanate, instead of the drug currently used, amoxicillin, because the addition of clavulanate helps to thwart the development of antibiotic resistance. The guidelines also recommend against using other commonly used antibiotics, due to increasing drug resistance.

While previous guidelines have recommended taking antibiotics for 10 days to two weeks, the new guidelines suggest five to seven days of antibiotics is long enough for the treatment of adults, and will not encourage bacterial resistance. The IDSA guidelines still recommend children receive antibiotic treatment for 10 days to two weeks.

Whether a sinus infection is bacterial or viral, decongestants and antihistamines are not helpful and may make symptoms worse, the guidelines say.

The voluntary guidelines are not intended to take the place of a doctor's judgment, but rather support the decision-making process, which must be made according to each patient's circumstances, the IDSA says.

The guidelines will be published in the April 15 issue of the journal Clinical Infectious Diseases.


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  • by Anon on Mar 23, 2012 at 10:32 AM
    Ralphie: "Obamabot"?? Why do you try and make something such as this article, political? Since when does suggesting on ways to improve something through research and advancement mean that you are a follower of Obama? Good God, open your mind.
  • by Anonymous on Mar 22, 2012 at 02:50 PM
    Wow! This is shocking! This is something I've known for years but knew wasn't being communicated to the public because big Pharma was trying to cover it up so they could keep getting all that money. What else do y'all think they aren't telling you? I bet you hadn't thought that maybe just maybe all those cancer drugs werent as effective as they want you to think. Why havent they cure AIDS or cancer? Because theres no money in it! Research the Gerson Therapy as well as megavitamin therapy. These two things cure disease naturally. Dig deep.
  • by over-medicated on Mar 22, 2012 at 09:23 AM
    Ralphie- what you are saying is absolutely absurd. obama and democrats have nothing to do with anyones sinus infection. It drives me crazy when people bring up politics where they have nothing to do with a subject. Anyway, Americans really need to start stepping back and reevaluate our medical practices. We are the number one medicated country in the world, and we have by far the most medical issues. Every medicine has side effects. All the processed foods we eat contribute to medical issues. Us and I believe maybe Australia are the only countries even allowed to broadcast commercials encouraging medicine. Im glad that people are looking into new guide lines for medicines. Will do our country good.
    • reply
      by Boats on Mar 22, 2012 at 10:59 AM in reply to over-medicated
      10-4..... :^)
  • by Uncle Sam Location: U.S.A. on Mar 22, 2012 at 09:13 AM
    People today are soft,get a little sniffle and start popping antibiotics.Back in the day we relied on our immune system.Got to wash your hands 40 times a day,use Purell all the time,just man up and let nature take its course.
    • reply
      by Anonymous on Mar 22, 2012 at 11:53 AM in reply to Uncle Sam
      Back in the day things turned into epidemics and killed thousands of people....they didn't have the drugs back then to start with.
    • reply
      by Anonymous on Mar 22, 2012 at 02:55 PM in reply to Uncle Sam
      Good hygein and eating habits are crucial for a healthy body. The mind is the most important tool to our health, stress is the worst thing for our health. I agree, too many people run to the doctor when they get sick. Research has proven that high doses of vitamins and fluids are just as effective as a lot of the medication on the market for respiratory and sinus infections. But, there's no money in vitamins. Gotta buy their pills..don't forget your refills..follow up appointment requested. Wake up people!
  • by ralphie Location: ahoskie on Mar 22, 2012 at 08:02 AM
    EVIL OBAMABOTS! I have benefitted from anti-biotics when I have had sinus infections. The evil pigs are simply trying to turn the world upside down. Democrats are EVIL
  • by Anon Location: USA on Mar 22, 2012 at 07:00 AM
    Really?..Your physician knows more about whether or not to precribe antibiotics than medical researchers? If that were the case then please explain the antibiotic resistant strains of bacteria we are seeing. I would think that most intelligent people would agree that overuse of antibiotics play a huge part in that. Yes, listen to your physician but do not run to him every time you get a sinus headache/drainage. He will feel compelled to prescribe something to you!
    • reply
      by Anonymous on Mar 22, 2012 at 07:37 AM in reply to Anon
      Anon, sorry you don't have confidence in your doctor like I do.....maybe you need to switch.
    • reply
      by Faye on Mar 22, 2012 at 08:22 AM in reply to Anon
      That is precisely why you should have a CBC to determine if the infection is viral or bacteria. If it's viral, you won't need the antibiotic.
  • by Faye Location: Belhaven on Mar 22, 2012 at 06:52 AM
    There is a simple test to tell the physician if the infection is viral or bacterial. It's a CBC(Complete Blood Count). This test differentiates and counts the blood cells to give the physician the diagnosis he/she needs to diagnose and treat the patient.
    • reply
      by Anonymous on Mar 22, 2012 at 09:07 AM in reply to Faye
      A culture as well may take two days for some bacteria to grow but again its a simple test.
      • reply
        by Anonymous on Mar 22, 2012 at 11:54 AM in reply to
        It's not a culture, it a blood test done in minutes.
  • by Anonymous on Mar 22, 2012 at 03:18 AM
    Major problems with this article. The word "unllikely" means they are not sure. And the statement "if the infection turns out to be viral".....again the the 'if" is a big maybe-maybe not. Take the antibiotics if prescribed by your physician......he knows more about your situation than these "experts" in an office in British Colunbia.
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