A Measured Discussion on Treating Sinusitis with Antibiotics
It has become something of an article of faith in recent years that we have a real and growing problem with unnecessarily prescribing antibiotics in this country. ENTs such as myself are often fingered as the biggest culprits – overzealous and under cautious, writing scripts willy nilly in the hopes of avoiding unlikely complications down the line.
I am generally on the side of the finger-pointers in this one, but I am careful to temper these opinions with an important caveat: when severe sinusitis is left untreated, it can become something far more serious.
Harvard’s excellent health site recently posted an article which agrees with this perspective, crystallizing the dichotomy at the heart of antibiotic use:
So how does one judge when it is appropriate to prescribe the antibiotic? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if it’s been less than 10 days, they meet criteria for antibiotic treatment. (That’s referred to as a “double-worsening” and is a common scenario in bacterial sinus infections.)
Absent vigorous treatment in cases like these, it’s possible to develop spreading infections which can reach the brain, and develop into dangerous abscesses.
So: watchful waiting, yes. Erring on the side of caution, yes. But there is such a thing as overcompensating in the wrong direction, and the diagnostic criteria above pretty much outline when that is.
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