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March 22, 2012
Sinus Infections Don't Require Antibiotics Yet They're A Leading Cause of Antibiotic Prescriptions


How many people do you that go to the doctor for every little cold or sinus issue? At least one in seven people are diagnosed with a sinus infection each year and most of them receive antibiotic medications. However, the vast majority of sinus infections are caused by viruses and should not be treated with antibiotics, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

Although sinus infections are the fifth leading reason for antibiotic prescriptions, 90 to 98 percent of cases are caused by viruses, which are not affected by antibiotics. Used inappropriately, antibiotics foster the development of drug-resistant superbugs.

“There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics ‘just in case,’” said Anthony W. Chow, MD, chair of the guidelines panel and professor emeritus of infectious diseases at the University of British Columbia, Vancouver. “However, if the infection turns out to be viral -- as most are -- the antibiotics won’t help and in fact can cause harm by increasing antibiotic resistance, exposing patients to drug side effects unnecessarily and adding cost.”

An analysis of nine trials published in The Lancet shows the drugs make no difference even if the patient has been ill for more than seven days. The infection of the sinuses - small air pockets inside the cheekbones and forehead - causes a high temperature, pain and tenderness in the face and forehead, and a blocked or runny nose. The Lancet research which looked at how long 2,600 patients were ill before they received treatment, found time of illness is not a good indicator of whether antibiotics will be effective. Because of side-effects, costs, and the risk of resistance, antibiotics are not justified even if patients have been ill for longer than a week, the researchers concluded.

The guidelines -- the first developed by IDSA on this topic -- provide specific characteristics of the illness to help doctors distinguish between viral and bacterial sinus infections. A sinus infection, called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role.

“These are the first evidence-based rhinosinusitis guidelines using the GRADE system,” said Thomas M. File Jr., MD, co-author of the guidelines and chair of the Infectious Disease Section at Northeast Ohio Medical University, Rootstown, Ohio. “Health care providers face difficulties when treating sinus infections, and these guidelines provide the best recommendations available. The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research.”

The IDSA rhinosinusitis guidelines contain a number of other recommendations, including:

  • How to tell the difference -- The guidelines note a sinus infection is likely caused by bacteria if:
    • symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days); or
    • symptoms are severe, including fever of 102 or higher, nasal discharge and facial pain lasting 3-4 days in a row; or
    • symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.
  • Avoid decongestants and antihistamines -- Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse.
  • Saline irrigation may help -- The guidelines note nasal irrigation using a sterile solution -- including sprays, drops or liquid -- may help relieve some symptoms.

To ease symptoms of a sinus infection, Dr. File said he recommends patients take use saline irrigation and drink plenty of fluids.

The voluntary guidelines are not intended to take the place of a doctor’s judgment, but rather support the decision-making process, which must be individualized according to each patient’s circumstances.

Six Natural Remedies For Sinusitis and Seasonal Allergies

1. Begin with a non-allergenic diet: Although allergens are external, it is actually our body’s response to them that is the cause of the allergy -- it is an allergic reaction. If your body is already inundated with food allergy triggers, your immune system will be hyper-wired to react to external allergens. Eliminate wheat, dairy, and excess sugar, the most common allergens.

2. Try a spoonful of honey: Choose local honey produced by bees that live in your area. The theory is that consuming honey may be much like immunotherapy, in the same way that allergists introduce tiny doses of an allergen to reduce sensitivity. As bees collect nectar from flowers, they inadvertently pick up pollen grains, which get into the honey, creating homeopathic immunotherapy.

Using honey as a preventive works best with a daily dose several weeks or months before allergy season.

3. Take vitamin C and quercetin: Vitamin C is a powerful antioxidant and also a mast cell “stabilizer.” Mast cells are tiny cells that line the mucous membranes, which when exposed to an allergen, release histamine.

Histamine in the bloodstream is the cause of symptoms such as, eye irritation, sneezing, and a runny nose. Vitamin C makes mast cells less reactive, thus reducing allergy symptom, and quercetin is a powerful flavonoid that enhances the effects of vitamin C.

Take 1500mg of vitamin C with 500mg quercetin at the first signs of allergies and repeat every four to six hours as needed. This crafty combination can put a sneezing attack to rest within 20 to 30 minutes.

4. Drink stinging nettle leaf tea: If you have come in contact with this perennial, you probably remember the sting. But it's safe and healthy in drink form. Steep the tea for 10 to 15 minutes to obtain the full benefits of the medicinal oils.

5. Inhale steam with essential oils: Bring water to a boil in a saucepan and then turn off the heat. Place 4 drops eucalyptus oil, 1 to 2 drops tea tree oil, and 3 drops rosemary essential oil. Drape a large towel over your head and inhale deeply for 5 to 10 minutes.

6. Give acupuncture a shot: Acupuncture can be effective, and it is thought that  acupuncture may temper an overactive immune system. Applied locally, it can help reduce nasal and sinus inflammation that is the cause of much of the discomfort from allergies.

Dave Mihalovic is a Naturopathic Doctor who specializes in vaccine research, cancer prevention and a natural approach to treatment.


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