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So as I was finally recovering from my recent RSV infection, a sinus infection developed. This is Day 7.
My doc prescribed amoxicillin 500 x 3 for 10 days last weekend, but since it hasn't really gotten worse and its recommended to wait 7-10 days to see if it clears up, I have not taken any. The idea is that most sinus infections are viral anyway, which seems likely in my case, so antibiotics won't do any good. But if it gets worse or lasts longer than 7-10 days then bacterial infection is usually assumed.
I plan to wait another day or 3 and see how things go before starting, but this has been remarkably stable and unchanging for 7 days. It hasn't been very bad, a few headaches and some pressure but very little congestion. Most of the time the only symptom is a vile, positively evil smell and taste. Saline rinses only seem to make it angry.
Anyway to the point: doc said make sure you take it for 10 days if you start, but who wants to take antibiotics for that long unless necessary, right? I'm seeing some recent information that longer courses aren't necessary, and that 5 days can be adequate
" Researchers from the CDC point out that, when antibiotics are deemed necessary for the treatment of acute bacterial sinusitis, the Infectious Diseases Society of America evidence-based clinical practice guidelines recommend 5 to 7 days of therapy for patients with a low risk of antibiotic resistance who have a favorable response to initial therapy." and "A systematic review of 12 studies found no significant difference in clinical cure rate, microbiological efficacy and relapse when 3–7 days versus 6–10 days of antibiotics were given for acute bacterial sinusitis.16"
The question for me becomes one of resistance-is using a shorter course of at last 5 days going to lead to antibiotic resistant bacteria being left over?
I really don't want to go against my doctors recommendations without good reason, but I am starting to question how up to date he is on some things.
Location: East Texas, with the Clan of the Cave Bear
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Quote:
Originally Posted by Deserterer
So as I was finally recovering from my recent RSV infection, a sinus infection developed. This is Day 7.
My doc prescribed amoxicillin 500 x 3 for 10 days last weekend, but since it hasn't really gotten worse and its recommended to wait 7-10 days to see if it clears up, I have not taken any. The idea is that most sinus infections are viral anyway, which seems likely in my case, so antibiotics won't do any good. But if it gets worse or lasts longer than 7-10 days then bacterial infection is usually assumed.
I plan to wait another day or 3 and see how things go before starting, but this has been remarkably stable and unchanging for 7 days. It hasn't been very bad, a few headaches and some pressure but very little congestion. Most of the time the only symptom is a vile, positively evil smell and taste. Saline rinses only seem to make it angry.
I use very warm saline water blast up each nostril of 5-7ml twice a day for any cangestion/infection in the sinus / nasal passages using a 10cc slip tip syringe
Anyway to the point: doc said make sure you take it for 10 days if you start, but who wants to take antibiotics for that long unless necessary, right? I'm seeing some recent information that longer courses aren't necessary, and that 5 days can be adequate
" Researchers from the CDC point out that, when antibiotics are deemed necessary for the treatment of acute bacterial sinusitis, the Infectious Diseases Society of America evidence-based clinical practice guidelines recommend 5 to 7 days of therapy for patients with a low risk of antibiotic resistance who have a favorable response to initial therapy." and "A systematic review of 12 studies found no significant difference in clinical cure rate, microbiological efficacy and relapse when 3–7 days versus 6–10 days of antibiotics were given for acute bacterial sinusitis.16"
The question for me becomes one of resistance-is using a shorter course of at last 5 days going to lead to antibiotic resistant bacteria being left over?
I really don't want to go against my doctors recommendations without good reason, but I am starting to question how up to date he is on some things.
If the offending bacteria is susceptible but is not totally wiped out (which is possible) in 5 days then wouldn't be wise to have taken your MD's advice and completed the 10 course. Physicians treat on instinct frequently and maybe in the last 2-3 weeks he's seen cases like yours requiring the more intense 10 day treatment to see better results.
CDC ? really? With all the misinformation they've thrown out here to us civilians in the last 2+ years. Yeah, listen to those non-practicing docs and bureaucrats if ya want. Or don't do a thing and you'll eventually get well or not. You gonna hold 'em or fold 'em?
There were only 10 rules chiseled in stone and brought down from Mt Sinai, and IIRC, a "10 day course of antibiotics" wasn't one of them....Many studies show shorter courses are effective with acceptable levels of relapse. The rate at which resistant strains survive the short courses is not determined, but theoretically increased.
Two problems with sinus infections-- (1) bacteria colonize the external nares, so doing a culture from a superifcial swab will probably grow bacteria. That doesn't mean thay's the cause of the infection, and (2) a sinus clogged with infected mucus is essentially an abcess, so antibiotics don't penetrate well and like any abcess, it needs to be drained or it won't get bettter.
I think any physical intervention like "flushing" only serves to shove the innocuous superficial bacteria back up where they don't belong...Breathing steam or using hot packs may temporarily open clogged sinus passages, but doesn't last long...."Decongestants" usually don't work all that well-- They may open the sinus a little, but also make the mucus drier & stickier- harder to drain out.
I've prescribed a short blast of prednisone for a day or three with good successs in cases where sinus pressure is severe and painful....The general aversion to using steroids in infections dates back to the first days of artificially produced hydrocortisone when TB was rampant and found to flare up wildy with use of the steroids-- but steroids affect cellular immunity much more than humoral, and TB control depends on cellular immunity, while viruses are fought mostly by humoral....The recent experience with steroids in CoViD seems to support my idea.
I recall having a post- viral respiratory head cold followed by a severe sinus infection a time or two that left my sinuses feeling like they were full of cement and my head and my head feeling like someone was pounding on the sinuses with a hammer. The taste and smell, I thought, was like something had crawled inside my head to die, and what came out when I tried to blow it was a small amount of bloody pus. At the time I worked in a hospital microbiology lab, so I cultured the discharge. The growth results came back as an equal quantity heavy growth of Staph aureus and Hemophilus influenzae, no normal respiratory seen. These two organisms can be present in normal respiratory flora in small quantities, with higher quantities of mixed normal flora and not cause problems, but with my culture results I figured I had the culprits and it was indeed a bacterial sinus infection.
I spoke to an infectious disease doctor who frequented our lab looking for culture results on his patients. I told him about my sinus culture and symptoms, and asked him about prescribing an antibiotic. He prescribed augmentin ( the Staph was not a MRSA) and instructed me to take nasal decongestants as well, drink plenty of fluids, use a steam inhalant, Vicks vapor rub, anything that would loosen up the goop in the sinuses. I can't recall the name of the nasal spray decongestant he recommended, it's very effective for short term use but there is a rebound effect which makes it less effective if used for more than a couple days. I used it short term, and blew my brains out while it was working to get rid of the stuff in my sinuses, and it got better over a week or so.
The doctor instructed me to be sure and use the decongestants, said they were just as important as, maybe more important, than the antibiotic in getting rid of that sinus infection. I've never forgotten that advice, and since then rely on decongestants, inhaled Vicks vaporub, sometimes oral decongestants to handle subsequent sinus issues without antibiotics. Fortunately, these measures have worked and I have since not had a sinus infection as bad as that one was.
First of all, ask doc why he/she prescribed a 10 DS. I haven't practiced in 5 years so I don't know the regimen for post RSV infections.
Then, I have to ask, why bother seeing a doc if you ignore their recommendations?
as I said, "I really don't want to go against my doctors recommendations without good reason, but I am starting to question how up to date he is on some things."
Here is another link suggesting shorter courses are more appropriate although it doesn't go into specifics.
So to answer your question, I don't want to ignore him but reasons to question his recommendations are cropping up. Fortunately I still don't feel its necessary to start them so I may be able to dodge the issue..until next time
There were only 10 rules chiseled in stone and brought down from Mt Sinai, and IIRC, a "10 day course of antibiotics" wasn't one of them....Many studies show shorter courses are effective with acceptable levels of relapse. The rate at which resistant strains survive the short courses is not determined, but theoretically increased.
Except that link I posted in response to Mike seems to undermine that idea, and suggests longer courses may actually propagate resistance
Quote:
Two problems with sinus infections-- (1) bacteria colonize the external nares, so doing a culture from a superifcial swab will probably grow bacteria. That doesn't mean thay's the cause of the infection, and (2) a sinus clogged with infected mucus is essentially an abcess, so antibiotics don't penetrate well and like any abcess, it needs to be drained or it won't get bettter.
Yep my doc said there's little point in culturing it-doing some head stands in last night's yoga practice seemed to help
Quote:
I think any physical intervention like "flushing" only serves to shove the innocuous superficial bacteria back up where they don't belong...Breathing steam or using hot packs may temporarily open clogged sinus passages, but doesn't last long...."Decongestants" usually don't work all that well-- They may open the sinus a little, but also make the mucus drier & stickier- harder to drain out.
Yeah I'm done with the saline rinses, they were not helpful at all and may have made it worse
Quote:
I've prescribed a short blast of prednisone for a day or three with good successs in cases where sinus pressure is severe and painful....The general aversion to using steroids in infections dates back to the first days of artificially produced hydrocortisone when TB was rampant and found to flare up wildy with use of the steroids-- but steroids affect cellular immunity much more than humoral, and TB control depends on cellular immunity, while viruses are fought mostly by humoral....The recent experience with steroids in CoViD seems to support my idea.
I had already been taking prednisone for the overall congestion for several days when the sinus infection started up-so I only took it for another couple days after that
Anyway today I am NOT going to do the saline rinse and see how that goes. Its not worse today and may be a little better after those headstands so I don't feel the need for antibiotics at this point.
I recall having a post- viral respiratory head cold followed by a severe sinus infection a time or two that left my sinuses feeling like they were full of cement and my head and my head feeling like someone was pounding on the sinuses with a hammer. The taste and smell, I thought, was like something had crawled inside my head to die, and what came out when I tried to blow it was a small amount of bloody pus. At the time I worked in a hospital microbiology lab, so I cultured the discharge. The growth results came back as an equal quantity heavy growth of Staph aureus and Hemophilus influenzae, no normal respiratory seen. These two organisms can be present in normal respiratory flora in small quantities, with higher quantities of mixed normal flora and not cause problems, but with my culture results I figured I had the culprits and it was indeed a bacterial sinus infection.
I spoke to an infectious disease doctor who frequented our lab looking for culture results on his patients. I told him about my sinus culture and symptoms, and asked him about prescribing an antibiotic. He prescribed augmentin ( the Staph was not a MRSA) and instructed me to take nasal decongestants as well, drink plenty of fluids, use a steam inhalant, Vicks vapor rub, anything that would loosen up the goop in the sinuses. I can't recall the name of the nasal spray decongestant he recommended, it's very effective for short term use but there is a rebound effect which makes it less effective if used for more than a couple days. I used it short term, and blew my brains out while it was working to get rid of the stuff in my sinuses, and it got better over a week or so.
The doctor instructed me to be sure and use the decongestants, said they were just as important as, maybe more important, than the antibiotic in getting rid of that sinus infection. I've never forgotten that advice, and since then rely on decongestants, inhaled Vicks vaporub, sometimes oral decongestants to handle subsequent sinus issues without antibiotics. Fortunately, these measures have worked and I have since not had a sinus infection as bad as that one was.
Mine has been very mild, just persistent as heck. Only a couple of mild headaches and some pressure and now and then. It really hasn't hindered my breathing much at all. The real villain is the smell and taste...I swear it burned my throat when I accidentally swallowed some yesterday.
Mine has been very mild, just persistent as heck. Only a couple of mild headaches and some pressure and now and then. It really hasn't hindered my breathing much at all. The real villain is the smell and taste...I swear it burned my throat when I accidentally swallowed some yesterday.
That sore throat might be caused by the microorganism causing the sinus infection, or possibly a result of irritation/inflammation from the contents of your sinus "stuffing". You may notice that sore throat when you wake up in the morning, from your sinus drainage going down into your throat as you lie on your back ( or sometimes side, I have found) when you are sleeping.
I guess whether or not you take your prescribed antibiotics for your sinus infection is a matter of debate. IMO your observation about the smell and taste of your sinus discharge suggests it could be a bacterial infection ( especially if it looks like pus and is bloody). If this is the case you might shorten the length of time you have the infection by taking the antibiotic, though the diligent use of decongestants ( the nasal spray I was thinking of in my last post was Afrin, but it only works for a few days before it becomes ineffective due to a rebound effect) will eventually get rid rid of it as well.
I'm sure you'd know it's time for an antibiotic, probably some more medical attention in the event you develop,a fever, swelling around your face, and other signs the infection is worse or spreading. Hopefully this won't happen.
That sore throat might be caused by the microorganism causing the sinus infection, or possibly a result of irritation/inflammation from the contents of your sinus "stuffing". You may notice that sore throat when you wake up in the morning, from your sinus drainage going down into your throat as you lie on your back ( or sometimes side, I have found) when you are sleeping.
I guess whether or not you take your prescribed antibiotics for your sinus infection is a matter of debate. IMO your observation about the smell and taste of your sinus discharge suggests it could be a bacterial infection ( especially if it looks like pus and is bloody). If this is the case you might shorten the length of time you have the infection by taking the antibiotic, though the diligent use of decongestants ( the nasal spray I was thinking of in my last post was Afrin, but it only works for a few days before it becomes ineffective due to a rebound effect) will eventually get rid rid of it as well.
I'm sure you'd know it's time for an antibiotic, probably some more medical attention in the event you develop,a fever, swelling around your face, and other signs the infection is worse or spreading. Hopefully this won't happen.
I don't have a sore throat. When I said it felt like it burned it was just a momentary sensation when I sucked some of the vile, toxic slime back into my throat.
Each day has been quite similar. I wake up and think it's gone. By mid-morning I start to smell it, and I'm able to hoooowwwkkkk a little vile yellow mucus/pus out, but only a very little, for a few hours. I doubt I get more than a quarter to half teaspoon out on any day. I have only seen a couple of very tiny flecks of blood. By mid-afternoon it usually feels like it's gone again unless I aggravate it with saline. At no time is my sinus completely clogged. It seems to be completely restricted to my right sinuses. I have no fever and don't feel sick since I finally cleared the RSV out of my lungs a few days after this started
I think one of my right sinuses just doesn't drain as well as the others, or this would have been gone. My right sinus has always been slightly problematic but not enough so to do any deep dives into the reasons. I may need to do more headstands to help clear it in the other direction.
As long as it doesn't get worse, I'm going to hold off on the antibiotics for at least a few more days.
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