Internist Questions sinus infection

Does every sinus infection need an antibiotic?

Every time I feel like I get a sinus infection, my doctor prescribes antibiotics as a last resort. Are antibiotics necessary for sinus infections?

2 Answers

Depends how severe it is. If very severe with fever and purulent secretions and lack of appetite then yes
No. In fact, the vast majority of what people call sinus infections do not need to be treated. Most are viral infections that just have more prominent symptoms and are commonly called sinus infections. The two scenarios that are more typical of sinus infections are 1) new onset acute severe localized pain (eye, cheek, forehead, or tooth) along with a new fever and sick feeling that occurs several days after what appears to be a resolving cold and 2) more than 2 weeks of heavy, thick, junky congestion with continued head pain/pressure often associated with an ongoing low-grade fever.

These are pretty much the only scenarios where antibiotics should even be considered, however, you still can resolve these issues without. Aggressive sinus rinsing (3-4 times daily) with either a Neti Pot or NeilMed squirt bottle is imperative. You can also add some antimicrobial compounds (peroxide, herbs, tea tree oil, etc.) to facilitate clearance. Hydration of 3-4 liters of water daily will help. Avoidance of gluten, dairy, and sugar for 2-3 weeks can also help. In the early days of the infection, regular zinc intake can help resolve it prior to escalation.

There are a few unique situations like imaging diagnosed sphenoid sinusitis that should always be treated, but that is rare. As a primary care physician, I've had a number upper respiratory and sinus infections over the past 20 years and never taken antibiotics once. I typically immediately start Zinc 30 mg twice daily, sinus irrigation 3-4 times daily, lots of hydration and avoidance of irritant foods, and eat lots of mushrooms (immune support), and that does the trick.