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Last month, after reporting on a study showing that antibiotics don’t work for most sinus infections, I received several comments from concerned readers who didn’t believe the study findings and swore that these drugs have quickly relieved their miserable congestion and sinus pain whenever they have had sinus infections.

But the flip side of this is that doctors are over-treating sinus infections -- which are usually caused by viruses -- with antibiotics, and that’s leading to an increase in antibiotic-resistant infections. For this reason, the Infectious Disease Society of America issued new guidelines on Wednesday calling for a halt to antibiotic prescriptions for most sinus infections.


The panel of physician experts who wrote the guidelines recommended that antibiotics be prescribed only for patients with the following sinus symptoms, which suggest a bacterial, not viral infection:

1. Those who have symptoms lasting for 10 or more days without signs of improvement

2. Those who have a fever (102 degrees F. or higher) combined with nasal discharge and facial pain that lasts for at least three or four days

3. Those who have a worsening of symptoms characterized by a sudden fever, headache or increase in nasal discharge following a cold that had begun to resolve.

Others, the guidelines recommend, should skip the antibiotics and give their symptoms a few days to clear on their own.

To relieve symptoms, the guidelines cited weak evidence that saline irrigation works to clear sinuses. Other options include saline nasal sprays or a neti pot -- which has a spout through which saline solution is poured gently into the nostrils. Steroid nasal sprays can also be considered for those with seasonal allergies, which can exacerbate congestion.

What I found surprising, though, was that the panel recommended against the use of decongestants or antihistamines for symptom relief since there’s evidence these remedies can make infections worse.


The guidelines also discussed what to do for patients who aren’t helped by antibiotics after a few days of treatment. They “should be referred to a specialist (such as an otolaryngologist, infectious disease specialist, or allergist) for consultation,” the guideline authors wrote, because sometimes surgical procedures or other drug treatments may be warranted.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.