Sinus Infection – Effective Treatment Options

So, I’m suffering from a sinus infection.

I’ve had it for about three days now, and it’s brought up something that I want to remind everyone about. First of all, let’s get our terminology down.

Common cold = acute upper respiratory infection = acute viral sinusitis

All of these things describe the same thing.  A cold is caused by a virus. It affects the respiratory tract.  Sinuses, throat, nasal passages, etc. The next thing I really want you to know is this:

I’m not taking antibiotics!

I’m all for the miraculous work of antibiotics when they’re needed.  And sinus infections may require antibiotics if they turn into a bacterial sinus infection.  This is often not suspected until 7-10 days into the course if the patient is worsening. The thing is, the most likely cause of my current symptoms is a virus.  Most cases of acute sinusitis are viral in origin. Antibiotics have no effect against viruses.  And that is why I am not taking any, and you shouldn’t either.

“But the doc told me…”

Unfortunately, however, antibiotics are frequently prescribed for this condition. A systematic review evaluating 15 studies including over 3,000 adults with uncomplicated acute sinusitis found that nearly half of patients improved by one week, and two-thirds by two weeks, irrespective of antibiotic use.  You see that?  It absolutely didn’t matter whether you took a Z-pack® or not.  It just gets better on its own. So give it some time folks.

Incidentally, one of my pet peeves as a doc is when I carefully explain all of this, and then a patient ends up getting antibiotics from another physician.  Then, lo and behold, 5 days later they are better, and attribute it to the antibiotics. Unfortunately, this just perpetuates the myth that antibiotics do anything for acute viral sinus infections.

The bottom line is this: There are no treatments that shorten the course of Acute Viral Sinusitis.  None. Is this hard as a doctor to tell patients?  You bet.

“Doc, can you fix me up from this sinus infection / cold / upper respiratory infection?”  

Me: “No, I can’t. I can tell you what to do to manage it. But it just has to run its course.”  

Man, do people hate to hear that.  And I hate to say it. But it’s the truth.

Over-the-Counter Treatment Options

What about OTC / symptomatic treatment?  Some OTC meds may help with symptoms, but none have ever shown any benefit in shortening the course. Go ahead and take them.  I’m taking pseudoepedrine (Sudafed®), and I find it to be very helpful for drying things out.  Be careful with this one if you have high blood pressure, though. And it can make you jittery.  (They use the stuff to make meth, so it can be a little “speed”-like).

Guaifenesin (Mucinex®) is one that I see people on all the time.  I know it has a great name. “Mucinex” really sounds like something that is going to get in there and break things up, and they have those disgusting cartoon commercials to really drive it home. Unfortunately, all the studies show it really doesn’t help.

So what to do:

  1. For discomfort – acetaminophen or ibuprofen.
  2. Nasal / sinus irrigation twice daily (Neti pot or squeeze bottle) followed by:
  3. Intranasal steroid (fluticasone or Flonase®) twice daily
  4. If OTC meds, use pseudoepedrine (Sudafed®).  Caution in patients with hypertension.
  5. Call Remedy! If you’re not sure, or want a flu or strep test, we can take care of that for you faster and cheaper than walk-in urgent care.

Ok, I’m off to go run the Neti pot through my nostrils.