Sinusitis, or a sinus infection, involves inflammation of the tissues lining the sinuses, air-filled spaces behind the forehead, cheeks, and nose. While many sinus infections are viral and resolve on their own, some are bacterial. Antibiotics treat bacterial infections, making them a potential treatment for bacterial sinusitis. Knowing when antibiotics are appropriate ensures effective treatment and promotes proper antibiotic use.
When Antibiotics Are Necessary
Viral sinus infections often improve within 7 to 10 days, similar to a common cold. A bacterial sinus infection is typically suspected when symptoms persist for longer than 10 days without improvement.
Antibiotics may also be considered if symptoms worsen significantly after an initial period of improvement, a phenomenon sometimes referred to as “double worsening.” Additionally, severe symptoms such as a high fever (above 102°F or 39°C) persisting for several days, intense facial pain, or noticeable swelling around the eyes or nose can indicate a bacterial infection. A healthcare provider evaluates these factors to determine if an antibiotic prescription is appropriate.
Common Antibiotics Prescribed
Amoxicillin, a penicillin-based antibiotic, is often a first-line choice. For adults, typical dosages range from 500 mg every 8 hours to 875 mg every 12 hours, usually taken for 5 to 10 days.
Amoxicillin-Clavulanate, known by the brand name Augmentin, combines amoxicillin with clavulanate, which helps overcome bacterial resistance. This combination is a frequent second-line option or is used when there is concern for resistant bacteria. Adults typically take 875 mg/125 mg every 12 hours for 5 to 7 days, or 500 mg/125 mg every 8 hours.
For individuals with penicillin allergies, or in cases where initial treatments are not effective, other classes of antibiotics may be used. Doxycycline is an alternative option for non-pregnant adults. It is typically prescribed at 100 mg once or twice daily, usually for a duration of 5 to 10 days.
Levofloxacin and moxifloxacin are fluoroquinolone antibiotics, generally reserved for specific situations due to their broader spectrum and potential side effects. Levofloxacin is often prescribed as 500 mg once daily for 10 to 14 days, or a higher dose of 750 mg once daily for a shorter 5-day course. Moxifloxacin is typically taken as 400 mg once daily for 5 to 10 days.
Important Considerations During Treatment
Taking antibiotics for a sinus infection requires adherence to the prescribed regimen to ensure effectiveness and minimize the risk of antibiotic resistance. It is important to complete the entire course of antibiotics, even if symptoms improve before all the medication is finished. Stopping early can allow remaining bacteria to multiply, potentially leading to a recurrence of the infection or the development of antibiotic-resistant strains.
Antibiotics can cause various side effects, with gastrointestinal issues like nausea, diarrhea, and stomach cramps being common. Taking some antibiotics with food can help alleviate stomach upset. Allergic reactions, though less common, can range from a mild rash to more severe responses like difficulty breathing or swelling of the face, lips, or tongue, requiring immediate medical attention.
It is important to avoid sharing antibiotics with others or using leftover medication from a previous illness. Each prescription is tailored to a specific infection and individual, and improper use can lead to ineffective treatment or other health complications. If symptoms worsen or new, severe side effects develop while on antibiotics, contacting a healthcare provider promptly is important.
Beyond Antibiotics
For viral sinus infections, antibiotics are not effective. Treatment focuses on symptomatic relief. Measures such as nasal saline rinses can help clear mucus and reduce congestion. Over-the-counter decongestants and pain relievers can also help manage symptoms like nasal stuffiness, facial pressure, and headaches.
If a course of antibiotics does not resolve a suspected bacterial sinus infection, or if symptoms are severe or recurrent, further evaluation may be needed. This could involve trying a different antibiotic, especially if there’s concern about antibiotic resistance or the initial choice was not fully effective. In some persistent cases, a referral to a specialist, such as an ear, nose, and throat (ENT) doctor, may be recommended for additional diagnostic tests or consideration of other interventions, including surgical options.