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Should all sinus infections be treated with antibiotics?
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The main determinate of treating a sinus infection is length of time of illness. 2-3 days of acute sinus pressure is extremely unlikely to be bacterial and is most likely either viral or allergies. Unfortunately, many providers prescribe antibiotics for viruses. The vast majority (about 90%) of sinus problems are directly due to allergies or viruses. Most sinus infections DO NOT require antibiotics. Most resolve using mucolytics such as guaifenesin, decongestants, nasal saline sprays, or steroid nasal sprays and sometimes steroids.
Am Fam Physician. 2006 Sep 15;74(6):956-966.; Gonzales R, et al. Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults: Background, Specific Aims, and Methods. Ann Intern Med. 2001;134:479-86, Best Practices in the Management of Patients with Acute Bronchitis/Cough 2016-2017; The Sinus and Allergy Health Partnership. Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis. Otolaryngol Head Neck Surg. January, Supplement 2004;130:1-45.; Chow AW, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012;54(8): e72-e112.; Snow V, et al. Principles of Appropriate Antibiotic Use for Acute Sinusitis in Adults: Background. Ann Intern Med. 2001;134:498-505.; Slavin RG, et al. The Diagnosis and Management of Sinusitis: A Practice Parameter Update. J Allergy Clin Immunol. 2005;116:S13-47 https://www.aafp.org/dam/AAFP/documents/about_us/initiatives/choosing-wisely-fifteen-questions.pdf