After my recent series about antibiotic use a reader asked a question about sinus infections.
“How do I know if I need an antibiotic for a sinus infection?”
It’s really a 2-part answer, so I’ll answer the second part first, it’s easier.
If you have a bacterial sinus infection with more than mild symptoms, an antibiotic may relieve symptoms and help you recover sooner.
So, you’re probably asking-
“How do I, or my doctor, know that I have a bacterial sinus infection?”
That is the more difficult question. Like so many things in medicine, maybe even most, figuring out what is wrong is the hard part. Once we know that, choosing one or more possible treatments is often rather straight forward.
If you think you have a sinus infection, you may have one of these alternate conditions–
The common cold, the most likely diagnosis- this is more correctly called acute viral rhinosinusitis. The medical prefix “rhino” refers to the nose, for obvious reasons.
Allergic rhinitis, commonly called just “allergies” or hay fever; again, a more correct diagnosis is allergic rhinosinusitis
Since the nose and sinuses are directly connected, problems in one part affect the other.
An abscessed tooth, or other dental problem
Cellulitis, an infection of the deeper layer of the skin
Zoster, known by its common name shingles; prior to the onset of the rash, there may be pain alone
Migraine– the headache of migraine can cause pain in the sinus area
Angioedema – You may not be familiar with this, it’s an uncommon type of allergic reaction characterized by swelling, mostly in the facial area. Once a patient called me requesting an antibiotic for a sinus infection. My office nurse wisely scheduled an appointment for her to see me. Rather than a sinus infection, she was experiencing angioedema from her blood pressure medication. These reactions can progress into life threatening swelling of the throat; I’m glad I didn’t try treating this with an antibiotic.
How do doctors diagnose a bacterial sinus infection?
The gold standard for diagnosing any bacterial infection is to identify the bacteria by growing it in a lab, a test called a culture. For that, we need a sample of the tissue or fluid from the infected area. Since the sinuses are deep in the face, there is no easy way to do this. So most of the time we rely on symptoms and exam. We look for
- Nasal congestion and/or drainage, which can be any color
- Pain and/or pressure in the sinus area including teeth
- Fever, which is a temperature about 100 degrees F or 37.7 C
- Symptoms have been present at least 7 days without improving
We consider prescribing an antibiotic when–
- Symptoms have been present 10 or more days, and/or are worsening
- Severe symptoms, such as pain not relieved with mild pain meds or persistent fever,
- People with conditions that impair their immune systems, like cancer and its treatment, or people with diabetes
- People with allergic rhinitis often seem to be more prone to bacterial sinus infections or take longer to get better
These of course are all general guidelines; every patient, every illness is different, so different approaches may be needed. This is a framework for us to work from, not hard and fast rules.
Other ways to feel better when treating sinus infections as well as colds, allergic rhinitis , bronchitis and influenza include rest, increasing oral fluids ,and moisturizing the nose and sinuses.
Portable humidifiers are an easy way to relieve dryness in the nose and sinuses.
A Neti pot or sinus rinse bottle are safe, easy ways to relieve dryness, congestion and clear out excess mucous from the nose and sinuses. Always use distilled or boiled water and ask your doctor before using.
Here is a link to a list of resources from the National Library of Medicine