Sinus Infections

The Infectious Diseases Society of America (IDSA) has issued new guideline on the diagnosis and management of acute bacterial rhinosinusitis, offering ways to distinguish bacterial from viral infection and stressing that antibiotic treatment is not necessary in the latter case.

Antibiotics kill bacteria, and are not recommended for most sinus infections because 90% to 98% are caused by viruses.

An infection probably has a bacterial cause and warrants antibiotics if symptoms last for at least 10 days and are not improving; if symptoms are severe, such as a temperature of at least 102° and facial pain for three to four successive days; and if symptoms worsen, usually after a viral upper respiratory infection of five or six days' duration that seemed to be improving, according to the guideline.

In patients who do have a bacterial sinus infection, the guideline recommends amoxicillin-clavulanate (Augmentin) to cover ampicillin resistant bacteria. Common antibiotics such as azithromycin (Zithromax), clarithromycin (Biaxin) and trimethoprim-sulfamethoxazole (Septra) are not recommended as first line antibiotics because of resistance issues. The guideline also recommends that antibiotic treatment in adults last five to seven days rather than 10 days to two weeks.

Whether viral or bacterial, sinus infections can be miserable. Analgesics, such as ibuprofen or acetaminophen are excellent for pain relief. Topical steroids (Flonase, Nasonex) have been shown to be beneficial. Medications that thin mucus, such as guaifenesin (Mucinex) promote drainage.