When does a sinus infection need antibiotics?

Antibiotics are not a good first choice for sinus infections (sinusitis)

People often are quick to ask their doctor for an antibiotic prescription when they suffer from a bad flu or sinus infection. These infections can be annoying, with congestion, headaches, pain across the face and never-ending mucus production. People just want to make the pain and discomfort go away and get on with their lives. That’s understandable, but antibiotics most likely won’t better their situation, as has been shown in countless studies. This is because sinusitis, like most infections of the upper respiratory tract, are caused by viruses, not bacteria, and antibiotics only treat bacteria.

Actually, taking antibiotics can make you feel sicker, by exposing you to potential side effects while your body is already weakened by a viral infection.  All antibiotics have side effects, so they should only be taken when it makes medical sense, such as when treating a bacterial infection.

More generally, you want to keep your antibiotics use at a minimum, as overuse of antibiotics can predispose you to colonization and infection by bacteria that can resist standard treatment. 

This isn't just on a personal phenomenon.  Antibiotic overuse is a threat to the whole of society. Decades of excessive antibiotics use have made bacteria increasingly resistant, and some common bacterial infections can now be fatal, as no antibiotics work against them. For example, treating urinary tract infections is becoming increasingly difficult in the U.S. as 30-40% of cases turn out to be resistant against antibiotics that used to be very effective in the past.

It is therefore recommended that antobiotics are avoided in the treatment of sinus infection, unless a severe infection is apparent.

When do sinus infections need antibiotic treatment?

Antibiotics may be needed when a secondary bacterial infection accompanies the primary viral infection. A clear sign of this will be high fever (>100 degrees) and facial pain that persists for more than five days.  Often times, a secondary bacterial infection will feel like a sudden relapse: your sinus infection was already improving and then suddenly worsens. If that’s the case, go see a doctor.  Also, if your sinus infection shows no signs of improvement after 10 days, it is best to see a doctor in person.  This is particularly true for children and for people with preexisting medical conditions.

What respiratory tract illnesses need antibiotics?

While sinusitis rarely requires antibiotic treatment, there are some respiratory diseases that warrant use of antibiotics more often. 

Pneumonia is one of them. Especially for young children and older people, pneumonia can potentially be life-threatening. Typical symptoms are cough, chest pain, high fever, breathing difficulties and generalized weakness. In particular, if you are suffering from shortness of breath, you should seek prompt medical attention.

Strep Throat is another respiratory illness caused by bacteria that sometimes requires the use of antibiotics. Its symptoms include a severe sore throat that is accompanied by high fever and swollen infected lymph nodes below your jaw on both sides of your neck. Swollen tonsils with white spots is another symptom. Strep throat does nnot cause a  coughing or a runny nose. If you suffer from the latter two, it’s most likely not strep throat.

References:

Schumann, Sarah-Anne, and John Hickner. “Patients Insist on Antibiotics for Sinusitis? Here Is a Good Reason to Say ‘No.’” The Journal of Family Practice, vol. 57, no. 7, 2008, pp. 464–8, www.ncbi.nlm.nih.gov/pmc/articles/PMC3183915/. Accessed 28 Jan. 2020.

Boisselle, Christopher, and Kate Rowland. “PURLs: Rethinking Antibiotics for Sinusitis: Again.” The Journal of Family Practice, vol. 61, no. 10, 2012, pp. 610–2, www.ncbi.nlm.nih.gov/pmc/articles/PMC3601684/. Accessed 28 Jan. 2020.