Do You Really Need Antibiotics for Your Sinus Infection?

“Doctor, I need an antibiotic for my sinus infection!” So, what’s behind that thinking?

Self diagnosis, frustration with not feeling better quick enough, desperation, or “I’m too busy to be sick.” A couple years ago at University of Pennsylvania, I moderated a discussion with my students. We had one student pretended to be a parent of a sick child expecting an antibiotic and the other student playing the role of doctor who knew there was no medical reason for prescribing it.

It’s very likely in the last 2 years, you were given an antibiotic for a cold, or acute bronchitis, or acute sinusitis. But as doctors, we know there is only 1 reason to prescribe an antibiotics – if you have a BACTERIAL INFECTION. According new guidelines released by the Infectious Disease Society of America, 90-98% of sinus infections not caused by bacteria, which means the antibiotic you got was very likley not going to help you.

So what, better to be safe than sorry right? Wrong. In February 2012, JAMA published a study that antibiotics don’t help, and may in fact hurt. Indiscriminate use of antibiotics breeds resistance and leads to a host of potential complications. All physicians including yours truly have cared for patients that developed side effects from antibiotics ; from diarrhea and rashes to the increasingly common Clostridium superinfection infection. In the past year, I’ve treated a patient where his only cure was removal of his colon. And according to the CDC, there are 14,000 deaths per year due to Clostridium super-infection.

And now we doctors have even more reason not to reflexively prescribe an antibiotic. Last week, the famous Z-pack, aka azithromycin received another, yes another, FDA warning that it is linked to dangerous heart rhythms and increased risk of death. In 2011, there were 55.3 million prescriptions of azithromycin. Imagine, you thought the sinus pressure was bad. Nothing beats death.

Typically I will prescribe an antibiotic in the case of sinusitis only if
a) persistent symptoms more than 7-10 days
b) fever >100.5
c) symptoms that initially improved but then relapsed
d) or you get frequent recurrent infections

So next time you want an antibiotic, think twice. They are not harmless. And for good measure, if you get a script, take a probiotic while you’re on it.

Here’s some good links if you think you think you have a sinus infection.
http://www.cdc.gov/getsmart/antibiotic-use/URI/sinus-infection.html
http://www.nlm.nih.gov/medlineplus/ency/article/000647.htm
http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm

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