QuestionQUESTION: Dearest DR Borucki
You mention the use of AFrin or similiar. How do you recomend using it??? I have had it suggested to me that it should be taken off the market as it makes too many side-effects.
I already use Nasonex I presume it is OK to use them both?!? What about oral decogestants the one's that don't give you the jitters? What are their names/brands?
The thing that bugs me about this sinus thing is that there doesn't seem to be any accurate way of determining whether it's a real bacterial infection vs Viral. "Requiring" antibiotics...
Perhaps you have seen this article.
Thanks for answering all my questions!!! Deeply appreciated.
If there is anything else you can think of that would be useful or have found helpful to your patients with these sinus complications/treatments PLEASE send them along.
Be Well,
Bless You, Ralph
Article FYI:
Sinus Problems: Do Antibiotics Help or Hurt?
Patients with painful sinus problems often plead with their doctors to give them an antibiotic ASAP.
About 90% of adults seen in the U.S. by a general practice physician do end up getting an antibiotic for acute sinusitis, research has found.
Acute sinusitis is a sinus infection that lasts less than four weeks. Chronic sinusitis lasts longer than 12 weeks. Infections of the sinuses, hollow air spaces within the bones in the cheek bones, forehead and between the eyes, are usually caused by viral or bacterial infections. They cause thick mucus blockage and discomfort of theses cavities.
But antibiotics may not always be the best remedy for sinusitis, according to recent research and physician experts.
Judicious use of antibiotics is now recommended by many agencies that have published guidelines, including practice guidelines issued jointly by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.
Research into Antibiotics and Sinus Infections
The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.
In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.
This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.
Patients who got no treatment were as likely to be better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.
The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.
Is Your Sinus Infection Caused by a Virus or Bacteria?
Physicians may not know if sinusitis is bacterial or viral, because the diagnosis is typically done by observing symptoms. Symptoms include:
Nasal congestion
Pain or discomfort around the eyes, forehead or cheeks
Cough
Headache
Thick nasal or post-nasal drainage
Sometimes other tests such as computed tomography (CT) scan or cultures are used to help make the diagnosis.
Despite the recommendations that antibiotic use be judicious, they are still overused for sinusitis, according to many physicians who specialize in treating sinus problems.
Some physicians say they give patients with sinusitis a prescription for antibiotics, and recommend they wait three to five days before filling it, and only fill it if symptoms are not better by then. A decongestant can be used to help relive your symptoms and promote drainage.
The longer symptoms last, the more likely a sinus problem is to be a bacterial infection, some experts say. Clear white mucus often accompanies a viral sinus problem, and yellow or green mucus more likely indicates a bacterial sinus infection.
When Antibiotics Are Appropriate Treatment
Antibiotics may be more appropriate to give to certain patients, such as those with diabetes, serious heart or lung disease, who are less able to fight off infection.
And antibiotics should be considered in patients with severe sinusitis symptoms, according to the practice guidelines from the American Academy of Allergy, Asthma and Immunology.
If antibiotics are given, a 10- to 14-day course is recommended, according to the practice guidelines. Amoxicillin is typically the first choice.
ANSWER: you are right... we don't know whether antib are indicated a lot of the time... I am pretty conservative and use antibiotics when other methods have failed. Afrin is a great med when used properly.... the naysayers who want it off the market see people who misuse it. Use it twice a day for 3-5 days when you have sinus pain/pressure from an infection. Using it for chronic allergies is a problem. It can be used with nasonex and other nasal steroids... those only work on symptoms caused by the allergic response, not infections.
Hope this helps...
---------- FOLLOW-UP ----------
QUESTION: Dear Robert Borucki:
I felt I needed to run this by you. I did end up on Keflex for about 7-10days and began to feel Nauseous and fatigued. So with much effort and the blessing of a doctor.(ALL of the symptoms had been gone for about 2-3 days) Not my regular PCP we stopped the Keflex. She mentioned that if it were to come back I would need to consider another antibiotic. She highly suggested Azithromycin. Her reasoning is that you don't have to take it as long and less likely to have the side-effects like I had that would cause one to have to stop it presumably earlier than ideal.10-14 days...
When I have taken an antibiotic in the past and it was definitely needed. I usually have side-effects the 1st day or two then my system adjust to it. It was just the opposite this time using an antibiotic. Which makes me still wonder if I ever really needed it? Although things did improve after the several days of dosing.
I would like and would really appreciate your "professional input" on this. As I mentioned to you before I do have a pre existing sinus related issues like allergies to dust mites,certain animal dander,chemical/environmental pollutants and a 1cm hole in my septum.
Thank you in advance for your care cooperation and attention to this important and somewhat perplexing health condition.
Sincerely Ralph
AnswerWith the hole in the septum... presumeably from past use of ... it may be not a great thing to use afrin... but it is safe in general, if used twice a day for 3-5 days for swelling from some short term infection. Using it chronically isn't good. Zithromax is easy to use, and a lot of docs use it because it is safe and easy, but true bacterial sinusitis is hard to cure with plain zpaks....
