Sinusitis Symptoms - Bacterial and Viral Upper Respiratory Infections - How to Know When to Use Antibiotics
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Bacterial and Viral Upper Respiratory Infections - How to Know When to Use Antibiotics

This is the time of year when we start seeing an increase in upper respiratory infections (URIs). School is in, kids are gathered together in classrooms, and germs get passed among them via sneezing, coughing, and lack of hand washing. And it doesn't take long for those germs to find their way into your household!

By the time you come to see me, you're feeling miserable - your head is stuffed up, your nose is running, your throat is scratchy, and you kind of ache all over. You're hoping that I can give you something to make you better.

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 But if you're generally in good health without any chronic illneses, you most likely have a viral infection. Unless you have one of these three bacterial infections, antibiotics won't be of any use to you. The most common bacterial URIs are:

ear infections (not that common in adults) sinusitis strep throat

Most other upper respiratory infections are caused by viruses. Let's go through each of these bacterial infections in a little more detail.

1. Ear Infections

More common in children because their eustachian tube is smaller and positioned so that bacteria from the nose and throat travel easily to the ear, hence they're more prone to ear infections. Whether to treat these infections should be decided based on the severity of the illness, and how long the child has been ill.

Adults do get ear infections and generally complain of moderatae to severe ear pain. The signs of an ear infection are pretty unmistakable. These people need antibiotics which clears up the infection pretty quickly.

2. Sinusitis - The symptoms are:

headache pain mid-cheek or between or behind your eyes achey upper teeth facial puffiness over one cheek

But here's the thing about sinus infections - they tend to clear up spontaneously within 10 days. Since most courses of antibiotics last for 10 days (it takes that long for the antibiotic to penetrate the sinuses and kill the bacteria), guidelines recommend that antibiotic treatment not begin until the patient has had symptoms at least 10 days. This is to prevent overuse of antibiotics.

Now guidelilnes are not mandates. If a patient come in, her cheek is puffy, she has a terrible pounding headache, and she hasn't been able to get any rest, I don't tell her to wait the 10 days - I treat her.

However, once it's clear the patient has a sinus infection and it's not severe, I explain the above and ask if she or he feels the sinus infection is severe enough to treat. When given a say in whether they should be treated, I find that patients often chose not to be on antibiotics.

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3. Strep throat

Ahh, the dreaded strep throat - a lot of people fear they have it but only about 5-10% of sore throats are caused by streptococcal infections ("strep" for short) in adults. Again, it's more common in kids (30%). Again, the vast majority of sore throats are caused by viruses. Here are the symptoms of strep throat:

enlarged tonsils with or without spots fever swollen glands severe sore throat no cough (generally no other symptoms like sneezing, runny nose, etc.)

Diagnosis is quick and easy with the rapid strep test swab - in minutes we can get the result. Improvement occurs generally within 24 hours once antibiotics have been started.

So what's the bottom line?

The majority of upper respiratory infections, in otherwise healthy adults, is caused by viruses and antibiotics will not cure them. The good news is that most viral infections last about 7-10 days. (If you have any concerns about your symptoms or you suffer from other chronic diseases that could compromise your health, you need to see your health care provider.)

Aside from decongestants and analgesics, what's the best treatment I can give patients to help them feel better?

I tell them to take a couple days of from work, curl up on the couch with a good book or video and rest, rest, rest!

As a family nurse practitioner and quality assurance manager of a busy 5 practice physician group, Margaret Mastrangelo has over 15 years of healthcare experience. In addition, she taught high school English for over a decade in Australia. Margaret has always been fascinated by the human body, why disease and illness occur, and the mind/body connection. She is a scuba diver and licensed private pilot and given any opportunity, you'll find her out flying. In her spare time, she is currently developing a health blog that provides health information for consumers. Visit her site at


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