Dear Dr. Roach: Every year and a half to two years, someone in our house gets a sinus infection. We are in our mid-60s, and it is always a fight with our doctor to get antibiotics to cure it. We go through at least two weeks of misery with nasal sprays, Tylenol, etc., before he finally decides that it is bacterial and prescribes the antibiotics. I understand that the use of antibiotics has gotten out of control, but I believe that antibiotics sometimes are needed. Should we have to fight this hard to feel well when we take antibiotics infrequently?
A: You're not going to like my answer, but I agree with your doctor.
Most cases of acute (less than four weeks of symptoms) sinusitis are caused by viruses. Up to 70 percent of common colds will show sinusitis on a CT scan, but less than 2 percent of symptomatic sinus infections are thought to be caused by bacteria -- even many of those will get better without antibiotics.
You certainly are right that sometimes the infection is bacterial and antibiotics are needed, but people can be spared the risks of antibiotics (many of which I have recently discussed, including C. difficile diarrheal infections) by just waiting long enough for the symptoms to get better on their own. Symptomatic treatments -- such as saline irrigation, steroid nasal sprays, a few days' worth of decongestants and, yes, Tylenol -- can relieve the misery.
Resistance to antibiotics is becoming a critical issue. I have seen patients die of bacterial infections because we have literally no effective antibiotics with which to treat them. For our own patients' safety and for public health reasons, we physicians need to prescribe less. I hope you understand why your doctor is being extra cautious about prescribing antibiotics.