Sinusitis, one of the commonest diseases seen by general practitioners (GPs) worldwide, happens to also be a condition that sees its patients frequently requesting antibiotics. Research estimates that nearly 90% of adults seen by GPs in the United States do indeed receive antibiotics for acute sinusitis. However, is it actually sensible to treat sinusitis with antibiotics?
In order to answer that, we have to understand how and why sinusitis occurs. Sinusitis refers to the inflammation of the lining of the sinuses, which are the air spaces located within your facial bones between your eyes, forehead and in the cheekbones. It occurs when blockage of the sinuses causes a fluid build-up, providing an environment for infection to occur. A majority of cases (about 50-70% of cases in children and about 90% of cases in adults) are caused by viral infections while the remaining minority cases are caused by bacteria or fungal infections.
Given these statistics, for most cases of sinusitis, antibiotic prescriptions seem insensible (for the majority of cases at least) because antibiotics simply do not work against viruses. Even if the underlying cause was indeed a bacterial infection, the American Academy of Allergy, Asthma & Immunology estimates that about 60-70% of sinus infections would actually resolve without any antibiotic treatment.
Many who come in demand antibiotics assuming they would help relieve the uncomfortable symptoms caused by sinusitis ranging from facial pain, stuffy nose, discolored nasal discharge as well as the pressure around the eyes, cheeks forehead that worsens when bending over. However, a study regarding symptom relief, published in the Journal of the American Medical Association has discovered that patients receiving antibiotics did no better than those who did not receive antibiotics.
Another reason for the fuss when it comes to administering antibiotics is the emergence of superbugs – bacteria resistant to multiple types of antibiotics – caused by the overuse and misuse of antibiotics. This has triggered an urgent movement worldwide advocating for judicious use of antibiotics to fight against antibiotic-resistant bacteria. For the patient, proper antibiotic usage ensures they too do not succumb to antibiotic resistance.
Some may argue, however, that if antibiotics are not given, there is a small chance that complications may arise from sinusitis. Indeed, unresolved chronic sinusitis may lead to a spread of the infection potentially resulting in meningitis (infection of the brain lining), osteomyelitis (infection of the bone), loss of smell and even vision problems. These complications happen to occur extremely rarely but are acknowledged nonetheless. Therefore, in order to address this risk, guidelines established a state that antibiotics become necessary in the treatment of sinusitis in the following situations:
- When a patient produces thick discolored nasal discharge and/or suffers from facial pressure/pain for 10 days or more.
- If a double-worsening occurs: This refers to when the patient experienced the symptoms mentioned above, saw an initial improvement but then symptoms become worse again, regardless of the duration of time.
Symptoms of sinusitis usually resolve within two to three weeks on its own in an otherwise previously healthy individual. Self-help steps that may help to relieve some of the discomfort includes medication such as nasal steroid sprays, fluids to ensure the body is hydrated and sufficient rest to fight of the infection.
Nasal irrigation, decongestants, antihistamines and mucolytics are frequently requested as well but be aware that there is insufficient evidence to recommend the use of these medications. And be aware that despite how common these medications are, they have potential to cause unwanted side-effects. In any case, consult your healthcare provider before using any form of medication and for further information read sinusitis treatment by DoctorOnCall on their website.