05-08-2006, 04:10 PM
Sinus infections are common.
Bacterial sinus infections (helped with antibiotics) are more unusual.
The fact that sinus infections may clear while using antibiotic use may just be a coincidence (it may have gotten better anyway).
Sinus pressure is best relieved by (1) drying up with an antihistamine (pseudofed), (2) ibuprofen for pain, and (3) something topical for swelling in the nose (where the sinuses drain) - eg. Flonase.
Treating sinus headaches/pressue with these three methods will usually work - the body's own immune system will get rid of the infection in a few days to a week.
In cases where there is bacterial overgrowth, and the immune system is not cutting it, an antibiotic should help. The catch-22 of treated bacterial sinusitis is that it requires a very long course of antibiotics - usually 21 days amoxacillin or 10-15 days of azithromicin / clarithromicin.
Biaxin (clarithromycin) and Zithromax (azithromycin) are macrolide antibiotics and have beomome a big hit because of (1) their broad spectrum - treating far more types of bacteria, and (2) their long half-life of elimination, allowing once daily or twice-daily dosing.
Infections treated with a short course of antibitics can return - often much worse than originally. Basically, you've killed off a large percentage of bacteria and have selected for the smaller population of bacteria resistant to your few doses of antibiotic. What returns can often be very difficult to treat. The worse cases of sinusitis I've seen are ones where the person took one or just a few days of antibiotic and then stopped when they felt better.
In short, I hesitate to treat sinusitis with antibiotics unless several criteria are met: (1) pain/pressure for a week, (2) tooth / upper jaw pain, (3) sinus pain with fevers. If the patient has any or all of these, I will usually treat - but with a much longer course of antibitoics. Sometimes, getting x-rays will help. A CT is diagnostic, but they are still relatively expensive and give a high dose of radiation.
Parents (I'm a pediatrician) often get angry when I won't give their child antibiotics.. "He is in pain." or "She can't sleep!", and being a parent myself, I sympathize. But the infection is often gone in a few days with just supportive measures, and in these cases, you've saved the kid (and the parents), many doses of probably unncessary antibiotics. Of course, there are a few kids who really do need antibiotics, and they come back in a few days with persistent pain.
You neighbor was being very nice, but he is exposing himself to an enormous liability. If you should have recurrent sinusitis with bad complications, he could get in very serious trouble - not to mention putting your own health at risk.
Here is some more information:
http://www.aafp.org/afp/981115ap/fagnan.html
The article contradicts what I've said a bit about length of treatment, but my experience has been that longer courses are often needed.
Good luck.
Sam V.
Bacterial sinus infections (helped with antibiotics) are more unusual.
The fact that sinus infections may clear while using antibiotic use may just be a coincidence (it may have gotten better anyway).
Sinus pressure is best relieved by (1) drying up with an antihistamine (pseudofed), (2) ibuprofen for pain, and (3) something topical for swelling in the nose (where the sinuses drain) - eg. Flonase.
Treating sinus headaches/pressue with these three methods will usually work - the body's own immune system will get rid of the infection in a few days to a week.
In cases where there is bacterial overgrowth, and the immune system is not cutting it, an antibiotic should help. The catch-22 of treated bacterial sinusitis is that it requires a very long course of antibiotics - usually 21 days amoxacillin or 10-15 days of azithromicin / clarithromicin.
Biaxin (clarithromycin) and Zithromax (azithromycin) are macrolide antibiotics and have beomome a big hit because of (1) their broad spectrum - treating far more types of bacteria, and (2) their long half-life of elimination, allowing once daily or twice-daily dosing.
Infections treated with a short course of antibitics can return - often much worse than originally. Basically, you've killed off a large percentage of bacteria and have selected for the smaller population of bacteria resistant to your few doses of antibiotic. What returns can often be very difficult to treat. The worse cases of sinusitis I've seen are ones where the person took one or just a few days of antibiotic and then stopped when they felt better.
In short, I hesitate to treat sinusitis with antibiotics unless several criteria are met: (1) pain/pressure for a week, (2) tooth / upper jaw pain, (3) sinus pain with fevers. If the patient has any or all of these, I will usually treat - but with a much longer course of antibitoics. Sometimes, getting x-rays will help. A CT is diagnostic, but they are still relatively expensive and give a high dose of radiation.
Parents (I'm a pediatrician) often get angry when I won't give their child antibiotics.. "He is in pain." or "She can't sleep!", and being a parent myself, I sympathize. But the infection is often gone in a few days with just supportive measures, and in these cases, you've saved the kid (and the parents), many doses of probably unncessary antibiotics. Of course, there are a few kids who really do need antibiotics, and they come back in a few days with persistent pain.
You neighbor was being very nice, but he is exposing himself to an enormous liability. If you should have recurrent sinusitis with bad complications, he could get in very serious trouble - not to mention putting your own health at risk.
Here is some more information:
http://www.aafp.org/afp/981115ap/fagnan.html
The article contradicts what I've said a bit about length of treatment, but my experience has been that longer courses are often needed.
Good luck.
Sam V.