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New sinus guidelines suggest no antibiotics needed for most

Kathleen Blanchard's picture
Experts say sinus infection treatment with antibiotics shouldn't be routine

Experts from the Infectious Diseases Society of America (IDSA) have updated guidelines for treating sinus infection. Surprisingly, the physician's group says you shouldn't take antihistamines or decongestants because they aren't helpful and could make things worse. New guidelines also recommend antibiotic treatment only for specific sinus infection symptoms that could mean bacterial infection. Most causes of sinus issues are from viruses.

No more antibiotics for sinusitis 'just in case'

Sorting out whether bacteria or virus is causing inflammation, headache and sinus pressure can be difficult. Taking antibiotics 'just in case' is no longer considered safe because of antibiotic resistance. Unnecessary prescriptions are also costly.

According to the IDSA in a news release, 90 to 98% of cases come from viruses, making it important to reserve antibiotics for sinus infections that last 10 days or more; not improving and accompanied by fever, nasal discharge and severe face pain that lasts 3 to 4 days in a row. Previous recommendations included at waiting just 7 days.

Background information from the IDSA media release states sinus infections are diagnosed in one in 7 people each year and inappropriate prescribing of antibiotics for treatment only creates more ‘superbugs’ from antibiotic resistance.

The IDSA has recommended staying away from antibiotics unless the clinician is reasonably sure, based on the above criteria, that bacteria and not a virus is invading the sinuses. For fever, severe facial pain, and nasal discharge antibiotic treatment should be prompt.

Complications of bacterial sinus infections are rare. In severe cases, abscesses can occur, cellulitis, which is a localized infection of the skin causing redness, pain and facial swelling and meningitis, according to MedLine Plus.

The antibiotic of choice for treating sinus infection from bacteria is amoxicillin-clavulanate, which is a major change from past recommendations to use just amoxicillin. The antibiotic is also recommended for anyone who has had a recent upper respiratory infection, seems to get better and then worsen with new symptoms of fever, headache and nasal discharge.

According to Anthony W. Chow, MD, chair of the guidelines panel and professor emeritus of infectious diseases at the University of British Columbia, Vancouver, "…if the [sinus] 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.”

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Chow said in a press release the switch to amoxicillin-clavulanate is an effort to overcome antibiotic resistance by inhibiting an enzyme that breaks down the antibiotic, which should be prescribed for just 5 to 7 days, versus other guidelines that suggest treatment for 10 days to 2 weeks.

He warns clinicians should resist the temptation to use other antibiotics such as azithromycin, clarithromycin and trimethoprim-sulfamethoxazole due to the potential for more ‘super-bugs’ that could develop; which is one of the major reasons for the new recommendations.

The new guidelines for treating sinus infection use the new GRADE system (Grading of Recommendations Assessment, Development and Evaluation) instead of relying on best evidence from clinical trials that fail to differentiate between bacterial and viral sinus infections.

What can you do at home for sinus infection?

Since most cases are cause from virus, try saline irrigation and sprays. Your doctor can prescribe a steroid nasal spray that might ease symptoms. Take pain medication such as acetaminophen to reduce fever and headache and drink plenty of fluids. Warm wash cloths placed on the sinus area can help ease facial pain. See your doctor immediately if your fever is 102 or above, you develop redness in the tissue of the face, neck pain or stiffness or other severe symptoms.

Respiratory infections, allergies and environmental irritants all play a role in rhinosinusitis, which is the term for sinusitis or sinus infection that can sometime last for weeks.

In the past, many physicians have prescribed antibiotics ‘just in case’. The infectious disease experts clearly discourage their use unless it’s reasonably certain you have a bacterial sinus infection.

The new sinus infection treatment guidelines from the IDSA are just recommendations and can be used to guide patient care. Your doctor should determine what treatment is right for you. It's also important to get your flu and pneumonia shots when recommended to cut down on the chances of upper respiratory infection.

IDSA News Release

Image credit: Bing
March 21, 2012