Advanced Pediatrics

Sinus Infections:  Myth and Reality

There is probably no more confusing problem amongst common problems than sinus infections and sinusitis.

The confusion comes from the rapidly growing trend to call a cold a sinus infection to open the door to use of antibiotics.

Here is what is typically taking place across the nation.  A person gets a cold, a runny nose and cough follow.
After some number of days, the runny nose and/or cough become so annoying that medical help is sought to relieve the suffering.  So far everything makes sense.

But the next step is where the trouble begins.  Once at the doctors office, either the person or the doctor raises the question of a sinus infection.  Often, the doctor will say one is present and prescribe an antibiotic.

Now, it turns out that antibiotics kill bacteria very well, but if your infection is from a virus, they do no good, only harm.

So what is the story with the "sinus infection?"  What is it, a viral or bacterial infection?  For many, many years, the assumption has been that it is bacterial and antibiotics are needed to get rid of it.

But, finally, someone actually tested that idea.  They took 166 adults who met all the rigorous criteria for having a sinus infection.  A random half got 10 days of antibiotic, the other half got placebo.  And what they found was that the two groups did about the same.  Both missed the same number of days of work, both got better about the same rate, only a slight improvement advantage on day 7 was noted for the antibiotic group.
http://www.nytimes.com/2012/02/21/health/research/in-sinusitis-antibiotics-are-as-effective-as-placebos-study-finds.html?_r=1&pagewanted=print

So, the study is clear, what we call sinus infections do not get better with antibiotics any faster than with sugar pills.  This makes it very likely that sinus infections are viral.

This actually makes a lot of sense.  Every cold, after all, is a sinus infection.  Viruses that cause colds never just infect the nose, they always also infect the spaces behind the nose, the sinuses. That's why when we have colds there is such a great, huge amount of mucus!

Now, it turns out that sometimes that mucus does get infected with bacteria and the mucus turns to pus.  As this study proves, that does not happen very often.  So how do you know when it does?

We would say if  your sinuses start getting very painful that may be a sign.  We do not mean the discomfort we all get with colds, but a shift to a very painful situation where tapping the face is very, very hurtful.

Just as importantly, there are several signs that many think indicate bacteria are now causing infection, but these signs do not mean you have a bacterial infection:

• mucus turning from clear to yellow or green
• having cold symptoms for a long time
• fever
• even white material filling the sinuses on CT or MRI scan- radiology images cannot distinguish between the mucus of a viral infection and pus of a bacterial infection.

This is why the study reported in the NY Times is so important.  It actually took nearly 200 people, each of whom met very stringent criteria for having sinus infection, each of whom had every reason to believe that their nasal congestion, runny nose, and cough indicated they had moved from a viral cold to a very bacterial infection, and none of them did.  Not a single person responded to antibiotic in a fashion seen in people with bacterial infections.   As noted the antibiotic did about as well as a sugar pill!

Bottom Line

So when you get a cold and have a runny nose, congestion, misery, cough, nose pain, you should know that almost certainly have an infection with a virus.  The very concept of a bacterial sinus infection is becoming suspect, and in most circumstances is simply an excuse to try a course of antibiotic, the famous "Z-Pak," for example.

Colds last a lot longer, create a lot more yucky mucus, and cause far more misery than we expect, or certainly more than we would like.

But we should respect the facts, and avoid use of drugs that we know will not work.

Key Point:  If you are infected with a virus, use of antibiotics can only harm, they do no good.

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