New Guidelines Discourage Antibiotic Use in Sinus Infections

Doctors should hesitate in prescribing antibiotics to patients with sinus infections, as up to 98% of the infections will not respond to them, said the authors of the new guidelines for treatment of rhinosinusitis from the Infectious Diseases Society of America.

Sinus infections can have both bacterial and viral sources, and because there is no simple test to distinguish between them, antibiotics are normally prescribed “just in case.” 

But, explains Anthony Chow, MD, of the University of British Columbia in Vancouver, "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."

The guidelines offer primary care physicians 18 recommendations to distinguish bacterial from viral infections and to ensure appropriate treatment. 

The guidelines suggest suspecting bacterial infections—the less common cause of sinus infections—when symptoms are persistent or last at least 10 days, when the onset is characterized by severe symptoms or a high fever, and when the disease gets worse after an upper respiratory tract infection that lasted 5 or 6 days and appeared to be improving. 

They also recommend a shorter treatment time of 5 to 7 days for adults and suggested that the normal treatment duration of 10 to 14 days for children should continue.  

-Michael Potts

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