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Published on April 14, 2017

The best medicine for this may be no prescriptionThe best medicine for this may be no prescription

Your head feels heavy, and there is pressure around your eyes and under your cheekbones that causes pain when you bend over. Thick mucus drains from your nose and throat. That cold you had may have turned into something worse – sinusitis.

You need to get antibiotics to clear this up, right? Well, don’t be surprised if you leave the doctor’s office or urgent care center without a prescription.

Why? Because viruses – not bacteria – cause the vast majority of sinusitis cases, and antibiotics are ineffective against viral infections. Not only that, but overuse of antibiotics has been blamed for the rise of so-called “super bugs” that are resistant to most antibiotics.

In addition, antibiotics can cause some unpleasant side effects, from an upset stomach and diarrhea, to more serious issues of severe allergic reactions and development of opportunistic infections, such as the gastrointestinal ailment clostridium difficile, more commonly known as “C. diff.”

“Antibiotics do have the capacity to hurt people,” said Shawn Hennessy, NP, a family nurse practitioner who works at the Yawkey Emergency Center at Falmouth Hospital, and at Stoneman Urgent Care Center in Sandwich and Falmouth Urgent Care Center.

“There are 2 million infections caused by antibiotics per year that result in 23,000 deaths (in the United States). Twenty-three thousand deaths that could have been prevented if someone maybe had not been on an antibiotic or prescribed a more appropriate antibiotic,” she said.

Antibiotics do have their place in medical care, when used appropriately, Hennessy stressed.

“Antibiotics are wonderful drugs, they play a critical role in saving lives, which is why we have an obligation as healthcare providers to make sure we are using them judiciously and appropriately, so that we can continue to rely on them well into the future,” she said.

Nine Out Of 10

The U.S. Centers for Disease Control and Prevention says viruses cause nine out of 10 adult cases of sinusitis and five to seven out of 10 pediatric cases. According to the Harvard Medical School, 85 percent of sinusitis cases get better without antibiotics. The school cited an article in the New England Journal of Medicine that recommends doctors tell patients that most sinus infections clear up in one to two weeks, and symptoms may be treated with over-the-counter medications, including nasal sprays, decongestants and pain medications, as well as nasal saline irrigation.

Sinusitis infections are among the most common complaints Hennessy sees, and she has often heard patients think they wasted their time if an office visit doesn’t end up with a prescription.

“What I say is, ‘You received an opinion that you’re well at this time and your body most likely can fight this off on its own, and this is good news.’”

But if a patient isn’t feeling better in a couple days, they should always consult with a healthcare provider, Hennessy said.

“I would always encourage someone to get checked out if they weren’t getting better or certainly if they’re getting worse.”

Several Causes

In addition to viruses, allergies, pollutants and fungal infections can also cause sinusitis, according to the CDC. It lists these risk factors for developing the condition:

  • A recent cold or other respiratory infection
  • A weak immune system
  • Allergies
  • Structural problems with the sinuses or nasal polyps

And, in young children:

  • Going to daycare
  • Second-hand cigarette smoke
  • Use of a pacifier
  • Drinking from a bottle while lying down

So how can you tell if you may need antibiotics?

Hennessy said each case needs to be judged individually, but generally, if symptoms of thick colorful discharge, usually accompanied by facial pain or pressure, persist for at least 10 days, antibiotics may be needed. A significant clue that bacteria are to blame is if symptoms had improved after a while, then returned.

A patient’s general condition and medical history go into deciding whether to prescribe an antibiotic and which one. Similar symptoms in a young, healthy person may get a different course of treatment than in someone who is elderly, has diabetes or lacks a spleen, Hennessy said.

“If you have a complex medical history, the safest choice is to get checked by your primary care provider; someone who knows your condition well,” she said.

The best antibiotic to use in most bacterial cases of sinusitis is Augmentin, she said. This drug combines amoxicillin, a penicillin-like antibiotic, with clavulanic acid, which helps prevent bacteria from destroying the amoxicillin, according to the U.S. National Library of Medicine. Hennessy said patients often request a “Z-pak,” or package of azithromycin, which she attributed to effective marketing. That drug might be appropriate for someone who’s allergic to amoxicillin, she said, but it is not the first or second choice for treating most cases of bacterial sinusitis.

“The data does not support using that for this,” she said.

If given an antibiotic, patients should take the entire quantity as directed, even if their symptoms improve before the course is completed, Hennessy said. They definitely should not self-treat by taking leftover antibiotics hanging around the house, she added.