What she really needed to know was whether her malady was a common cold caused by a viral infection, which would be unresponsive to antibiotics, or a sinus infection caused by a bacterium that could be snuffed out quickly with an antibiotic. A difficult problem, as the symptoms of acute sinusitis are often quite similar to those of a cold.
Sinusitis is suspected when continued headaches or facial pain and tenderness are added to the usual cold symptoms. To complicate things, though, acute sinusitis is often also caused by a viral infection. But in cases where a bacterial infection is the culprit, the symptoms may resolve more quickly with antibiotic treatment.
Even though my daughter had no facial pain, I recommended that she ask her physician for an antibiotic because her nasal discharge had turned from yellow to green — an unscientific rule of thumb I have used for my own bouts of colds vs. sinusitis. And her symptoms and nasal discharge did in fact disappear almost completely after taking the antibiotic for four days.
But now, in hindsight, I was probably wrong to recommend an antibiotic. And that hunch was strengthened by a report in the December 5 issue of the Journal of the American Medical Association (JAMA). In this study, 240 adults were diagnosed with acute sinusitis — all study participants had either a yellow or green nasal discharge and many had facial pain and tenderness.
These people were randomly assigned either to a placebo, an antibiotic (amoxicillin), or a nasal steroid spray for one week ... but antibiotic treatment did not significantly reduce the recovery time from acute sinusitis. My daughter's recovery was probably just a coincidence and unrelated to the antibiotic.
Here's my best advice if you come down with what feels like sinusitis:
- Don't rush to your doctor for common symptoms of a cold, even if you have a headache or facial pain. Try putting up with them for at least two weeks. In the JAMA study, symptoms lasted for more than 10 days in about a third of those who were managed with or without the antibiotic.
- Don't demand or expect a prescription for an antibiotic if you do see your doctor. (This may be a moot point since about 90 percent of U.S. physicians routinely prescribe an antibiotic for suspected acute sinusitis.) There are many reasons to avoid unnecessary use of antibiotics. They can cause diarrhea and other side effects, trigger an allergic reaction, and, most worrisome, encourage the growth of resistant strains of bacteria.
- Do check with your doctor if you have persistent (longer than two weeks) nasal discharge, headaches, fever, or facial pain and tenderness. Obviously, a trip to your doctor is warranted whenever headaches and facial pain not only continue but worsen over time.
In the end, you know your body and previous experience with colds and sinusitis best. Each person must use his or her own common sense in considering the broad suggestions I have made.
