How do you know when you need antibiotics for a sinus infection?

[Greta]

I've been sick with an unusually bad head and chest cold for a week. On Saturday night, I got that horrible pressure of sensation that indicates a sinus infection (I've had lots of them in the past) so I went to urgent care on Sunday morning.

 

This doctor was extremely reluctant to give me antibiotics. They had signs up in the exams rooms saying, basically, don't expect antibiotics. I know they have very good reasons for being careful with them, and I have personally very good reasons for not wanting to take them (I had chronic digestive problems when I used to have to take them more often, and I still have food sensitivities that I developed during that time. I know they will trash my delicate digestive system.). He wrote me the prescription but told me not to take it unless I got worse.

 

Unfortunately, I didn't think to ask questions like, "how much worse?" and "by when will I get better if this isn't bacterial?" He said he thought it was just my allergies combined with the cold, and told me to double my allergy medication (Flonase). But surely I should be over the cold by now (today is day 8 of the cold), and this doesn't feel the way my allergies usually make me feel. And the increased allergy medication hasn't helped. I started taking sudafed, and it helped a lot on Sunday, but doesn't seem to be working anymore.

 

I had another rough night last night (like Saturday night) where I couldn't sleep because my sinuses were so stopped up, and the mouth-breathing thing makes me snore and cough. So in the middle of the night I was thinking that I'd go ahead and take the antibiotics this morning. Now that I'm up, *one* side has cleared to the point that I can breathe some through my right nostril.

 

Oh, I had a mild fever at the appointment (99.3 and my normal body temperature runs low, never gets above 97.3) but I don't know if that was an infection or just the cold. Unfortunately my home thermometer doesn't seem to be working, so I can't give you any current numbers. I don't feel any more feverish, if anything slightly less.

 

Sorry this is long. So to sum it up, my current symptoms are:

Sinus pressure and discomfort

Mild Headache

Cough

ETA: dizziness

Runny nose

Reduction in sense of smell and taste

Fatigue, weakness, general malaise, sick of being sick!

 

Try to wait it out a bit longer? Or start the meds?

[Penguin]

I have no idea what you should do, but  :grouphug: .

 

Your dilemma is recurring one for me, and I am pretty much in the same situation as you right now. 

[Greta]

I have no idea what you should do, but :grouphug: .

 

Your dilemma is recurring one for me, and I am pretty much in the same situation as you right now.

Ugh, I'm sorry you have to deal with this too! Have you found anything that works as a prevention, or a treatment if you catch it early enough? Many, many people have told me that using a neti pot was a miracle for them. It does NOTHING for me. :(

 

Thanks for the :grouphug:

 

:)

[texasmama]

I would take the antibiotics at this point.  

[Katy]

I wait more than two weeks or until it's turning into bronchitis.  I take that more seriously because I have a tendency to get serious pneumonia very quickly.  I have never once had a reluctance to give antibiotics when I waited two weeks.

[Greta]

I would take the antibiotics at this point.

Thank you! Everyone I have asked IRL (hubby, mom, etc) has just said, "it's up to you" or similar. So nice to get a real answer! :)

[texasmama]

You are welcome!  I am not one to take unnecessary antibiotics, but if you are still having that many symptoms for this long, I would call it.

[redsquirrel]

I have only been given antibiotics for a sinus infection when I could point to the spot on my face where the infection was focused (usually under a cheekbone) and (sorry to say this) I had yellow stuff coming out of my nose in quantity. The headache was sever and I was using an ice pack or hot pack on my cheekbone to reduce the pain.

[Greta]

I wait more than two weeks or until it's turning into bronchitis. I take that more seriously because I have a tendency to get serious pneumonia very quickly. I have never once had a reluctance to give antibiotics when I waited two weeks.

I've only had pneumonia once in my life, and it was pretty awful! I've had a lot of sinus infections, though.

[DesertBlossom]

I have a tendency to get sinus infections. I've found a Neti Pot works really well. I have to be diligent about using it twice a day. I add the recommended salt plus one drop of Grapefruit Seed Extract. It takes a few days, but it will clear it up.

[Greta]

I have only been given antibiotics for a sinus infection when I could point to the spot on my face where the infection was focused (usually under a cheekbone) and (sorry to say this) I had yellow stuff coming out of my nose in quantity. The headache was sever and I was using an ice pack or hot pack on my cheekbone to reduce the pain.

That sounds like the first one that I ever had. It was pretty bad before I went to the doctor, but after that I started going to my doctor sooner because I recognized the symptoms quicker. But he always confirmed that he could clearly see that it was an infection before giving me the drugs. This doc said it didn't look like an infection (two days ago). And I know what you mean about the yellow stuff, and I don't have that this time. It's clear. Is that a sign that it's NOT an infection? Now I'm confused again! :lol:

[Greta]

I have a tendency to get sinus infections. I've found a Neti Pot works really well. I have to be diligent about using it twice a day. I add the recommended salt plus one drop of Grapefruit Seed Extract. It takes a few days, but it will clear it up.

I've never tried it with grapefruit seed extract. Perhaps that's the magic ingredient. But I don't think I could use a neti pot right now, because the left side is *completely* stopped up.

[redsquirrel]

That sounds like the first one that I ever had. It was pretty bad before I went to the doctor, but after that I started going to my doctor sooner because I recognized the symptoms quicker. But he always confirmed that he could clearly see that it was an infection before giving me the drugs. This doc said it didn't look like an infection (two days ago). And I know what you mean about the yellow stuff, and I don't have that this time. It's clear. Is that a sign that it's NOT an infection? Now I'm confused again! :lol:

 

I don't know for sure, but that is among the first questions I get asked when I have gone to see someone. And I know around here they use that as a line for keeping kids home from school/activities. If a child/teen has a runny nose and it is clear then it's no problem. But if it is coloured beyond first thing in the morning then stay home. So I have always thought that was a sign of infection, but again, I don't know for sure.

[Greta]

I don't know for sure, but that is among the first questions I get asked when I have gone to see someone. And I know around here they use that as a line for keeping kids home from school/activities. If a child/teen has a runny nose and it is clear then it's no problem. But if it is coloured beyond first thing in the morning then stay home. So I have always thought that was a sign of infection, but again, I don't know for sure.

Thanks, I'll see what Google can help me find out.

[redsquirrel]

Once, when I didn't have health insurance I think I got rid of an infection on my own.  I sat down with chips and a really spicy salsa (which I love) and I just kept blowing my nose again and again until the yellow stuff stopped coming out.  Then I did it again later.  After about three or four rounds of very intense blowing of my nose (and several boxes of tissue) I felt a whole lot better.  And I had eaten a lot of delicious spicy salsa so I was happy, lol.

 

It got gross though, lol. Like, spectacularly gross. I didn't care at the time because it really was making me feel better.

[Greta]

Once, when I didn't have health insurance I think I got rid of an infection on my own. I sat down with chips and a really spicy salsa (which I love) and I just kept blowing my nose again and again until the yellow stuff stopped coming out. Then I did it again later. After about three or four rounds of very intense blowing of my nose (and several boxes of tissue) I felt a whole lot better. And I had eaten a lot of delicious spicy salsa so I was happy, lol.

 

It got gross though, lol. Like, spectacularly gross. I didn't care at the time because it really was making me feel better.

Hey, if it would make me feel better, at this point I don't care about the gross factor at all!

[gardenmom5]

do your cheeks hurt?

do the bones above your eyes hurt?

do the bones at the top of your nose hurt?

any other facial pain?

if pain isn't obvious - try pressing with your finger tips and see if anything hurts.  it should be noticiable, especially if you are pressing down. if the tissue beneath is inflamed - it will feel like pressing on a new bruise or infected boil.

I will almost always have some kind of facial pain with an infection, even if I only notice it when pressing my face.  (I've even had TMJ type pain which originated in my sinuses.)

 

I will also feel dizzy - my head is heavy and doesn't want to stay upright.

 

I find guiffenison (re: muscinex) is a huge help in thinning secretions so they can drain. 

I also take ibuprophen as it is an anti-inflammatory.

drink tons of water.

Sudafed, zinc (I do optizinc from NOW).  you can also try a neti-pot to rinse the sinuses. (warm saline solution doesn't hurt)

 

I've even sniffed fresh crushed garlic (it has antibacterial, antiviral, and antifungal properties.) I found I got it up into my sinuses that way more than just eating it.  raw, unprocessed honey does too.  I've mixed the two and put it on toast.

 

I also ate spicy food - wasabi is great for clearing sinuses.

 

btw: for which antibiotic did the doc give you a scrip?  I found amoxicillin is positively worthless for me when I have a sinus infection, but is what most docs are willing to give.  (stronger ones will have gross gunk draining like mad.)  I had a kidney infection in april - and I was on a pretty strong antibiotic so my sinus were draining like mad.  I ended up with a 2nd course of a z-pak for the sinuses.  I've since had a third course (another 5-day z-pak)  -which my doc didn't want to do and neither did I, but my cheeks really hurt and other signs.

[gardenmom5]

Once, when I didn't have health insurance I think I got rid of an infection on my own.  I sat down with chips and a really spicy salsa (which I love) and I just kept blowing my nose again and again until the yellow stuff stopped coming out.  Then I did it again later.  After about three or four rounds of very intense blowing of my nose (and several boxes of tissue) I felt a whole lot better.  And I had eaten a lot of delicious spicy salsa so I was happy, lol.

 

It got gross though, lol. Like, spectacularly gross. I didn't care at the time because it really was making me feel better.

 

when blowing - remember to ONLY blow one side at a time.  hold one side closed while you blow.  that will keep gunk from going further back and making things worse.

and drink a lot of water!  the spices will send water to mucus membranes so they'll move.

 

phad thai a little spicier than I normally eat.  so, whatever spicy food appeals to you.  sushi with wasabi . .

 

 

eta: clear is not an infection. (other than a basic cold. maybe.)  it could be allergies, it could be inflammation from other causes than bacterial/viral. (reaction to diet) pale yellow is the beginning of infection, and most people with a healthy immune system can fight it without rx.  an infection that may need treatment is likely to be dark yellow - to green to even brown.

[Bluegoat]

If it is running clear, it isn't a bacterial infection.  Even then, you don't necessarily need antibiotics - I get one or two of those a year, and only once did I ever need antibiotics.

 

As far as things to help - there are these things that are a similar idea to a neti-pot, but they just shoot the saline up your nostril, and you might find that works better.

 

Also, sometimes if you can just get them to drain for a bit, it then will clear up.  I tend not to use sinus meds,even the day ones make me so dopey I can't drive,  but if it gets bad I will take some and probably about a third of the time the sinus won't refill even after the drugs wear off.  Other things I have found that work are really spicy food and, weirdly, sex.

[Greta]

Thank you, Kristin! I actually don't have facial pain, but I don't remember having that before either. Tenderness when touched, yes. Especially on my left side. But certainly not as bad as a boil or anything like that.

 

Dizziness comes and goes. It has been pretty bad a few times.

 

Yes, amoxicillin. :( Ten days of it! For someone with my history, would a shorter course of a stronger antibiotic be better or worse on my digestive system? I could contact my PCP and see if he would give me a different scrip than the one the doc at urgent care gave.

 

I did not know that about blowing only one side at a time. I think I have some wasabi!

 

Thank you so much for your help.

[Greta]

If it is running clear, it isn't a bacterial infection.

Okay, good to know!

 

Also, sometimes if you can just get them to drain for a bit, it then will clear up. I tend not to use sinus meds,even the day ones make me so dopey I can't drive, but if it gets bad I will take some and probably about a third of the time the sinus won't refill even after the drugs wear off. Other things I have found that work are really spicy food and, weirdly, sex.

 

I've been sick and disgusting for a week now - my husband has been loving me from afar! :lol: And I don't blame him!

 

The air is super dry here (desert). Steam seems to help. But a person can only stand so many hot showers or baths when it's in the 80's outside.

[gardenmom5]

Thank you, Kristin! I actually don't have facial pain, but I don't remember having that before either. Tenderness when touched, yes. Especially on my left side. But certainly not as bad as a boil or anything like that.

 

Dizziness comes and goes. It has been pretty bad a few times.

 

Yes, amoxicillin. :( Ten days of it! For someone with my history, would a shorter course of a stronger antibiotic be better or worse on my digestive system? I could contact my PCP and see if he would give me a different scrip than the one the doc at urgent care gave.

 

I did not know that about blowing only one side at a time. I think I have some wasabi!

 

Thank you so much for your help.

 

it does sound like you are starting one - whether you can treat without antibiotics I don't know.  has amoxicillin worked for you in the past?  (it does for some people.  not me.) If it has worked for you, it should work for you.  if it doesn't, then you'd require something stronger.

 

my experience with urgent care is only for the desperate who don't want to pay for the ER on weekends. (I don't have much confidence in urgent care.)  we've STILL ended up in ER three times after urgent care.   including when I had pneumonia . . . . . . ('cause I was pg, he didn't do an x-ray, so called it bronchitis and gave me a 3-day z-pak. . . . I ended up in the ER 2 days later, x-rays and admittance to the hospital on IV antibiotics and anti-emetics.-  the iv antibiotics made me very sick.)

the fact is - urgent care docs dont' know you, they don't have a file on you - and yes, it matters. some people make mts out of mole hills, and some people make mole hills out of mts.  it affects treatment and your doctor knows which one you are.

 

 

eta: steam. boil a pot of water, add several cloves of freshly crushed garlic, then throw a towel over your head over the steaming water for 15 minutes.

[Greta]

it does sound like you are starting one - whether you can treat without antibiotics I don't know. has amoxicillin worked for you in the past? (it does for some people. not me.) If it has worked for you, it should work for you. if it doesn't, then you'd require something stronger.

Well, I'll try to get by without the antibiotics - do all the things people have recommended here first. See how I feel in a couple more days.

 

my experience with urgent care is only for the desperate who don't want to pay for the ER on weekends. (I don't have much confidence in urgent care.) we've STILL ended up in ER three times after urgent care. including when I had pneumonia . . . . . . ('cause I was pg, he didn't do an x-ray, so called it bronchitis and gave me a 3-day z-pak. . . . I ended up in the ER 2 days later, x-rays and admittance to the hospital on IV antibiotics and anti-emetics.- the iv antibiotics made me very sick.)

the fact is - urgent care docs dont' know you, they don't have a file on you - and yes, it matters. some people make mts out of mole hills, and some people make mole hills out of mts. it affects treatment and your doctor knows which one you are.

I definitely got the feeling that this doctor felt he had more important things he could be doing. My history was available to him (same system as my PCP, it's all on computer), but not only did he not look at that, he didn't even bother to look at the vitals that the nurse had taken when she checked me in. Oh well.

 

 

eta: steam. boil a pot of water, add several cloves of freshly crushed garlic, then throw a towel over your head over the steaming water for 15 minutes.

Thanks, I'll try that!

[Greta]

Oh, and yes the amoxicillin has worked for me in the past.

[Acadie]

I had a sinus infection this winter that wasn't going away, and like you, I really hesitated to take abx due to a history of digestive issues.

 

This worked for me--I just went completely crazy doing every alternative I could think of, including hydrating like I never have before.  After 2 or 3 days of this, I felt like the tide had turned, and within 10 days felt much better.  Most people would not go to these lengths to avoid abx, but I've seen what they do to my family in the past.  If this had not helped, I would have done the abx with very high dose probiotics both during and after the course.

 

So I made a chart to keep track of all this daily--

10x big glasses of clear liquids

3x 1 c water with 1 tsp apple cider vinegar dissolved in it

3x vitamin C

1x vitamin A

1x vitamin D3

1x zinc

1x curcumin supplement (Ehnansa)

3x steam treatments (shower, head over a bowl of hot water with a towel, etc)

1x probiotics

2x colloidal silver

lots of extra sleep

kimchi--I read it contains a beneficial bacteria that decreases sinus infections somehow

 

Basically I was doing everything I thought would support my immune system, decrease inflammation, and hydrate/loosen up the gross stuff.  I really think crazy hydration is necessary to treat a sinus infection--my gut tells me that was one of the most important things.  When I was googling for alternatives, I noticed that many people who do take abx say their infections came back until they really hydrate and take care of themselves.

 

Amy

 

[Carol in Cal.]

I rarely get sinus infections, but when I do, I can't seem to clear them without antibiotics, and amoxicillin works just fine.

 

I like Neti pots for prevention, but they don't work for cure. 

 

How I know it's an actual infection:  If I tap my cheekbones they hurt a lot.  If I bend over, my forehead and ears feel a lot of pressure.  I usually have a mild but persistant headache that aspirin won't touch.  Then I take Sudafed, and if it's a sinus headache without an infection yet, the Sudafed will help a lot in about half an hour, so I keep taking it every 4 hours along with Neti pot use, until the symptoms clear completely.  If that doesn't work, and I feel increasingly tired and/or weak, it's an infection and it's time for drugs.  Usually this is at the tail end of a cold or allergy that has lasted for over a week. 

[Catherine]

Sinusitis has been a target of efforts to reduce unnecessary antibiotics therapy because the data has shown that most people (40-70 percent, diagnosed by symptoms alone) with acute bacterial sinusitis get better without antibiotics, AND because it has been identified as a condition in which overuse of antibiotics is a big problem. 

 

ITA with those posters who've recommended what they call "extreme" measures to manage the condition without antibiotics. Hydration, steam, irrigation, and in some cases, antihistimines, guaiafenesin, decongestants, can all be tried.  A meta-analysis that looked at 51 studies found that 80 percent of people with bacterial sinusitis who did not take antibiotics got better, and 90 percent o those who did take antibiotics got better. 

 

 

[Greta]

I had a sinus infection this winter that wasn't going away, and like you, I really hesitated to take abx due to a history of digestive issues.

 

This worked for me--I just went completely crazy doing every alternative I could think of, including hydrating like I never have before. After 2 or 3 days of this, I felt like the tide had turned, and within 10 days felt much better. Most people would not go to these lengths to avoid abx, but I've seen what they do to my family in the past. If this had not helped, I would have done the abx with very high dose probiotics both during and after the course.

 

So I made a chart to keep track of all this daily--

10x big glasses of clear liquids

3x 1 c water with 1 tsp apple cider vinegar dissolved in it

3x vitamin C

1x vitamin A

1x vitamin D3

1x zinc

1x curcumin supplement (Ehnansa)

3x steam treatments (shower, head over a bowl of hot water with a towel, etc)

1x probiotics

2x colloidal silver

lots of extra sleep

kimchi--I read it contains a beneficial bacteria that decreases sinus infections somehow

 

Basically I was doing everything I thought would support my immune system, decrease inflammation, and hydrate/loosen up the gross stuff. I really think crazy hydration is necessary to treat a sinus infection--my gut tells me that was one of the most important things. When I was googling for alternatives, I noticed that many people who do take abx say their infections came back until they really hydrate and take care of themselves.

 

Amy

Thank you! I've been forgetting to take my vitamin D lately, and that seems to make a big difference in my immunity. Thank you for the reminder!

[Greta]

I rarely get sinus infections, but when I do, I can't seem to clear them without antibiotics, and amoxicillin works just fine.

 

I like Neti pots for prevention, but they don't work for cure.

 

How I know it's an actual infection: If I tap my cheekbones they hurt a lot. If I bend over, my forehead and ears feel a lot of pressure. I usually have a mild but persistant headache that aspirin won't touch. Then I take Sudafed, and if it's a sinus headache without an infection yet, the Sudafed will help a lot in about half an hour, so I keep taking it every 4 hours along with Neti pot use, until the symptoms clear completely. If that doesn't work, and I feel increasingly tired and/or weak, it's an infection and it's time for drugs. Usually this is at the tail end of a cold or allergy that has lasted for over a week.

Thank you - according to your tests this isn't an infection. Yay!

[Greta]

Sinusitis has been a target of efforts to reduce unnecessary antibiotics therapy because the data has shown that most people (40-70 percent, diagnosed by symptoms alone) with acute bacterial sinusitis get better without antibiotics, AND because it has been identified as a condition in which overuse of antibiotics is a big problem.

 

ITA with those posters who've recommended what they call "extreme" measures to manage the condition without antibiotics. Hydration, steam, irrigation, and in some cases, antihistimines, guaiafenesin, decongestants, can all be tried. A meta-analysis that looked at 51 studies found that 80 percent of people with bacterial sinusitis who did not take antibiotics got better, and 90 percent o those who did take antibiotics got better.

Wow, this is good to know. Thank you for sharing this!

[Catwoman]

I would have taken the antibiotics long before now. I'm no doctor, but your symptoms are lasting awfully long for it not to be an infection. It doesn't sound like standard allergy symptoms to me. It sounds like you're ill.

 

Is there a reason why you are anti-antibiotics? (Not being snarky -- I'm really wondering! :))

[TravelingChris]

I really appreciate people not taking antibiotics when they have a virus or if their bodies are strong enough to counter a mild bacterial infection.  As a person on strong immune suppressants, I get sick badly very fast. I do get put on antibiotics because with the underlying illnesses I have make it much likely that I will have complications and a longer course and the immune suppressants mean my body won't fight back as well

 

Greta, it sounds like you have a viral infection if it is clear and antibiotics won't help.  Even I, with my underlying diseases and problems, don't take antibiotics for what is a virus until it turns bacterial.

[The Governess]

The couple times I had a sinus infection, I felt so much pressure in my cheekbones every time I bent over.  Even then, I only resorted to antibiotics once.  Flonase was the biggest help, because it shrunk those swollen tissues down so the yucky stuff could get out.  Since you were already taking it, it might be a few days before you feel a difference with the higher dose - it was usually day 3 or 4 after starting the flonase that I felt it was really working.  You may also try taking ibuprofen, which can reduce inflammation, and even ice - think one of those cold eye masks you can put in the freezer.  Cold drinks. 

 

Hope you feel better!

[JumpyTheFrog]

I've read that many sinus infections may actually be fungal and not bacterial in nature. I haven't looked to see if there is evidence for this or not.

[KrissiK]

I get sinus infections a lot. And for me.... I just know. There comes a point where I am exhausted. I'm sleeping 10+ hours a day, and I can just tell my body isn't going to fight this. So, I go to the doctor. Sometimes, though, I feel like I can push in through, I up my probiotics and get through it.

[Greta]

Is there a reason why you are anti-antibiotics? (Not being snarky -- I'm really wondering! :))

Perfectly valid question! Several years ago, I was getting frequent sinus infections and had to take antibiotics several times a year. I developed chronic diarrhea - sorry, I know, TMI, but you asked! :) I became very sensitive to grains, and I still can't eat them to this day without bloating and pain and diarrhea. I'm afraid that if I take more antibiotics, my problem will get worse, and I'll develop even more food sensitivities!

 

This doctor at urgent care also said that new research is showing a correlation between antibiotic use and subsequent development of diabetes. I had some minor blood sugar issues before, but they got worse, and I now have insulin resistance and reactive hypoglycemia. Possibly coincidence, but I hate to do anything that would increase my chances of diabetes.

[Greta]

Flonase was the biggest help, because it shrunk those swollen tissues down so the yucky stuff could get out. Since you were already taking it, it might be a few days before you feel a difference with the higher dose - it was usually day 3 or 4 after starting the flonase that I felt it was really working.

Oh, thanks for mentioning this! Maybe it will "kick in" soon then. Thanks for the other suggestions too.

[JumpyTheFrog]

I became very sensitive to grains, and I still can't eat them to this day without bloating and pain and diarrhea. 

 

I wonder if you developed SIBO (small intestinal bacterial overgrowth).

[Greta]

I wonder if you developed SIBO (small intestinal bacterial overgrowth).

I don't know. Thanks for the link.