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20-03-2012 | General practice | Article

Sinus infections mostly viral in origin


IDSA website

MedWire News: The majority of sinus infections or acute rhinosinusitis cases are viral in origin and therefore antibiotic use in sufferers should be kept to a minimum, suggest new guidelines published by the Infectious Diseases Society of America (IDSA).

"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,' " said Chair of the guidelines committee Anthony Chow (University of British Columbia, Vancouver, Canada) in a press statement.

"However, 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 authors say that even though almost one in seven people in the USA have at least one sinus infection every year only 2-10% of such infections are caused by bacteria, with the rest being viral in origin.

The guidelines provide information to doctors on how to differentiate between the two types of infection. Specifically, if a sinus infection is bacterial in origin and therefore a candidate for treatment with antibiotics then the guidelines say that symptoms should be present for 10 days or more; should be severe - for example high fever (38.9°C [102°F] or above), nasal discharge, and/or facial pain for at least 3-4 days in a row; or should get worse over time - for example, presence of new fever, headache, and/or increased nasal discharge.

The IDSA committee also notes that bacterial sinus infections typically occur after a respiratory tract infection of at least 5-6 days in duration that initially seemed to get better.

If bacterial infection is present then the guidelines suggest that amoxicillin-clavulanate should be prescribed where possible due to increasing resistance against amoxicillin. They also advise that 5-7 days of antibiotic treatment is adequate for treating bacterial sinus infections without increasing the risk for antibiotic resistance, rather than the commonly recommended 10-14 days.

Another important point made by the authors is that decongestants and antihistamines are not helpful for improving symptoms of either viral or bacterial sinus infections and may actually make symptoms worse. By contrast, nasal steroids may be helpful for people with sinus infections and a history of allergies.

Saline irrigation is cited as a potentially effective method for alleviating symptoms, but the writers of the guidelines concede that such a therapy may be more effective in adults than in children, who are less likely to tolerate the discomfort of saline irrigation.

"Healthcare providers face difficulties when treating sinus infections, and these guidelines provide the best recommendations available," fellow IDSA committee member and guidelines co-author Thomas File, from Northeast Ohio Medical University, Rootstown, USA, told the press.

"The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research," he added.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Helen Albert

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