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Have bacterial sinus infection. Is it necessary to take antibiotic?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2561 Questions

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Posted on Fri, 4 Jan 2013 in Asthma and Allergy
Question: Hello, I have had a bacterial sinus infection for three weeks but it has been getting progressively better. It started as a viral cold and then progressed after a few days to a more severe secondary sinus infection. The first ten days were the worst with major congestion, sinus headache, and intense fatigue. However, my only current symptom is yellow sinus drainage for a few hours during the day (oddly it goes away at night). I would rather not go on an antibiotic if I can get over this on my own---but is an antibiotic necessary to avoid a chronic sinus condition? I am using "Neilmed" saline sinus rinse to keep the drainage from backing up. Honestly, if it wasn't for the colored mucus I wouldn't be concerned but this has never happened to me before. I have a history of sinus issues but they have always been acute and have cleared up relatively quickly.
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Answered by Dr. Sumit Bhatti 54 minutes later
Hi,

Thank you for writing back.

1. You seem to have had a severe cold and sinusitis (copious yellow mucus drainage, headache and fatigue). Bacterial infections may be confirmed with examination of the yellow nasal discharge.

2. Mucus drainage earlier in the day (and reducing at night) points to a frontal or ethmoidal sinusitis. Repeated attacks over the years leads to thickening of the nasal and sinus linings leading to worse attacks over time, as the sinus openings are narrowed.

3. If you have no fever or cough, then you may get a prescription for supportive medication from your physician and avoid antibiotics. If symptoms do not subside, get a Sinus X-ray / plain Scan CT PNS (Para Nasal Sinuses) done.

4. Anti-inflammatory, anti-allergic, mucolytic, decongestants, a medicated gargle along with steam inhalation may help. You may use the saline nasal rinse, however avoid using it in acute infections as it may cause the infection to spread. Later anti-leukotrienes and steroid nasal sprays may help.

5. Keep a local physician's informed. Hypothyroisim worsens symptoms and delays recovery.

6. A warm, humid environment and keeping yourself well hydrated by drinking warm liquids is recommended. Avoid sour, spicy and cold liquids.

7. If gross nasal problems such as DNS (Deviated Nasal Septum) and Hypertrophied nasal turbinates are ruled out, Balloon Sinuplasty is an option.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti 13 minutes later
Thank you so much for the information, very helpful. Would antibiotic use make it less likely for those passages to narrow? In other words, the longer the infection lingers does it create more problems? Again, I don't want to take antibiotics unless totally necessary but I also don't want to set myself up for long term issues. How long does an acute bacterial sinus infection generally last without antibiotics? Also, I am confused: I was told by an otolarynologist specifically to use the saline during acute attacks to shorten the duration? In your opinion this is not a good strategy? Thanks!
doctor
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1. The antibiotic will only help if there is an active bacterial infection. A positive nasa / throat swab, sputum examination, routine blood tests or worsening symptoms may necessitate antibiotic use.

2. A Bacterial sinus infection may heal in a couple of weeks or may become chronic.

3. Avoid saline nasal washes are avoided during acute infections and in immediate post operative patients for 48-72 hours.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti 43 minutes later
Thank you so much! I had no idea not to use saline washes during acute infections. So you are suggesting that when you get a cold / sinus infection not to use the saline rinse? I thought that was the whole purpose of the saline rinse? How long do you suggest waiting until you use the rinse to help get rid of excess mucus? I have always thought it helps but now I am worried!
Thanks again, you have answered my questions much more clearly than the ENT I saw (who diagnosed bacterial sinusitis). And one last question: the ENT told me that bacterial sinusitis never gets better on its own. Is that true? Sounded odd to me.
Thanks so much for your help. I hope that I can consult you again next time something comes up for me.
doctor
Answered by Dr. Sumit Bhatti 7 hours later
Hi,

Thank you for writing back.

1. Avoid saline nasal washes for the initial 48-72 hours of a cold. Saline washes are fine in the recovery phase. Acutely inflamed mucosa (inner lining of the nose) is very sensitive. There are many other factors such as the exact salinity of the solution, introduction of additional infection and so on. The nasal cavity and sinuses are lined by a ciliated mucosa and a blanket of double layered mucus. Disrupting this too often will also interfere in the normal functioning of these nasal sinuses. A thorough rinse of the nose is easier than that of the sinuses. The sinuses are designed such that they fill with air mainly while breathing out.

2. The body's natural immunity, healing powers, supportive treatment and rest help clear any infection. Antibiotics help by reducing the bacterial load. Antibiotics are recent medications (only since the 1930's) in terms of the human evolution. Allergy, fungal and viral infections add to the severity of the sinusitis.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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