When should I come to the doctor about – Sinus infection
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I treated a patient for a minor injury yesterday. One of the things he mentioned to me was he did not know when he should come in. I was reassuring him that an injury he sustained was minor but in the past he had waited and when he went to the doctor he had been told he should have come in earlier. I thought that was a common dilemma so I will be writing about common problems and how to self treat them and when to come in to see your health care provider. This discussion is about sinus infection.
The Joint Council on Allergy, Asthma and Immunology an educational arm of the American Academy of Allergy, Asthma and Immunology, has established some criteria for the diagnosis of sinus infection. Their list of symptoms includes:
1. Presence of persistent upper respiratory infection (congestion in the nose and throat.
2. Purulent rhinorrhea (pus in the mucus from your nose)
3. Heavy post-nasal drainage associated with a cough at night
4. Pain in the face or in the teeth (upper teeth)
5. Headache associated with a persistent “cold” (10-14 days)
Symptoms should have persisted for a couple of weeks. If you have a fever over 100.4, or have asthma, nasal allergies or polyps, a history of x-ray confirmed sinus infection that reoccurs frequently then seeking treatment sooner rather than later is advised. If you are in good health with no illnesses that predispose you to sinus infection there are some things you can do initially.
Nasal saline irrigation with a small spray bottle ($1.50 at most chain pharmacies) 5 or 6 times a day will help relieve your symptoms. Guiafenesin (Mucinex and others) has proved to do no harm and may help mucus in the sinuses drain more easily. Topical decongestants are helpful but can only be used for 3-5 days and no more than twice daily (these are especially useful if you have to fly somewhere, use them an hour before your flight and irrigate with saline in-flight). Be sure your practitioner feels these are O.K. for you to use.
If you irrigate, and use Mucinex and decongestants (no antihistamines – you want the mucus to come out not dry up in an infection) and have the above symptoms or are not getting better after 10-14 days then going to “the doctor” is recommended.
Antibiotic resistance, meaning the bacteria are successful in preventing an antibiotic from harming them, is a big problem. It takes larger doses of antibiotics to do the job. That is why it is appropriate to wait if you are just congested without fever. Using symptomatic therapy until you fail to improve is important.
Let your practitioner choose your antibiotic. So many of my patients tell me “a Z-pack works best for me”. Frankly, in most cases, if a Z-pack works for your sinus infection, saline probably would have worked also. Azithromycin is a good drug but rarely for sinus infection. Augmentin is still the drug of choice in patients not allergic to penicillin. The Sanford Guide, published yearly, also recommends alternatives for people allergic or intolerant of Augmentin.
When you are prescribed antibiotics, take them all as directed. Continue with saline irrigation, and symptomatic measures also. Eating a live-culture yogurt (Stoneyfield, Dannon Activa) or taking probiotics (Jarrow and others that are capsules containing fluid and require refrigeration – about $10 for 90) helps prevent antibiotic associated diarrhea. If you don’t improve, a screening CAT scan of your sinuses or referral to an ENT specialist is indicated.
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