Rhinosinusitis, commonly referred to as an upper respiratory infection (URI), is one of the most common reasons people seek medical attention. Adults can acquire a URI 2-3 times a year (commonly 8-10 times a year for kids). We all know the nagging symptoms: nasal obstruction and congestion, thick nasal drainage, facial pressure and fullness, and cough with or without fever. Over 85% of these episodes are caused by a virus (and not by a bacteria), meaning antibiotics will not help. Yet, many times we run to the closet UTC once these symptoms start and hope for an antibiotic. So many antibiotics are prescribed it’s like an episode of the Oprah Winfrey Show…”You get an antibiotic! You get an antibiotic! Everybody gets an antibiotic!” However, if antibiotics won’t work most of the time, what can we do?
Many studies have been done over the years looking at what helps reduce symptoms and shorten the duration of the infection. Based on the research, here is what I recommend:
1. Zinc gluconate lozenges every 2-3 hours
2. Vitamin C 500 mg three times daily
3. Elderberry extract (Sambucus nigra) four times daily
These all have been shown to reduce the length of the illness, but it’s very important that you start them as soon as the symptoms begin and continue them until complete recovery.
I also recommend Ibuprofen, OTC Mucinex, and oral and nasal Decongestants as directed as needed to relieve symptoms.
So when is an antibiotic needed? The American Academy of Otolaryngology: Head and Neck Surgery has clinical practice guidelines based on multiple systemic reviews. Based on the most up-to-date research, they recommend antibiotics if symptoms persist without improvement for more than 10 days, or if symptoms worsen within 10 days after an initial improvement in symptoms (known as double worsening). Otherwise, treating the symptoms as I discussed earlier is recommended.
Of note, another treatment has been shown to help symptoms in pediatric patients (over the age of 12 months): a teaspoon of honey once a day. They’ll love it too!
It’s important to note I’ve only been discussing simple acute infections. For patients with recurrent episodes of infections (at least 4 times per year) and/or with chronic (never fully resolving) symptoms, then more aggressive management likely would be beneficial. These would include allergy testing and possible immunotherapy (allergy shots or drops), or procedures such as in-office balloon sinuplasty or endoscopic sinonasal surgery. If you or a family member experience these forms of sinus infection, then a full examination by an ENT physician is recommended.
Rhinitis diagram
Antibiotics have a great and important role in treating many aggressive bacterial infections. However, the progressive emergence of resistance by various bacteria to commonly used antibiotics (mainly from overuse and unneeded prescriptions) demands appropriate and judicious use by physicians and patients. If you have further questions or concerns, then reach out to your local ENT to help.
