With OTC Meds
Do I Need to See
Bacterial sinus infections generally need the attention of a physician. There is often a period of time where symptoms are not quite severe enough to be sure that a true bacterial sinus infection is present. It is during this time that several OTC medicines, if used correctly, can be helpful.
It has been shown that many acute bacterial sinus infections will resolve without antibiotics. If symptoms are mild, then the following may be helpful.
Nasal decongestant sprays (Afrin and others). If you think you are on the brink of a bacterial sinus infection, then this is your first stop. 2 sprays in each nostril every 12 hours for 3 days. You should also take Sudafed if you can tolerate the side effects. Antihistamines are traditionally not recommended at this time, especially the older classes which tend to dry mucous membranes. Rinsing with saline nasal rinses is recommended, most pharmacies now stock improved nasal saline products.
If the symptoms of bacterial sinusitis persist or worsen, you need to see a doctor.
Your doctor can examine you, discuss your specific symptoms, and then give a recommendation that is tailored to your specific situation.
Antibiotics are the key when bacterial sinusitis is diagnosed. The correct selection of antibiotics depends on several complicated factors. The simplest is often the best. For patients who have milder symptoms, infrequent infections, and a history that doesn't include prolonged infections, first line antibiotics should be used, the usual treatment duration is 10 days.
Patients who have had to take frequent antibiotics, those with histories of recent prolonged infections, or in patients who have already failed one or more rounds of antibiotics; I use broader spectrum antibiotics, in higher doses, for longer periods of time. Often for 3 or 4 weeks, and then follow up with some type of radiologic study if any symptoms persist.
Depending on the situation and allergies, my preferred antibiotics are - second generation cephalosporins – Augmentin – Flouroquinolones . Each has its place and occasionally other categories are appropriate.
When allergic rhinitis is present at the same time as sinusitis, it is helpful to treat the allergies also. Steroid sprays and oral steroids, reduce allergic swelling and can help encourage drainage.
At some point it is necessary to see a specialist. The Otolaryngologist, especially one with special interest in sinus and nasal problems, is the best doctor for sinus problems.
Field of expertise
Perhaps it is time to see an ENT specialist. Surprisingly, appointments are often easy to schedule, they do not require a referral from a primary care doctor, and the cost of specialist visits can be less than a visit to your family doctor.
- Decisions about antibiotic treatment based on experience with difficult sinus cases
- The timing and most efficient use of x-rays and CAT scans
- Special examination techniques such as endoscopic exams in the office
- Endoscopically directed cultures are the modern standard when culturing infected material is appropriate
- Orchestration of intravenous antibiotics for some patients
- Use of advanced topical preparations such as atomized or instilled antibiotics and anti-fungals where appropriate
- Treatment of complications of acute sinusitis such as sinus related abscesses.