Sunday Morning Debate: Viral or Bacterial?
Claire Berlinski, Ed. ·
January 15, 2012 at 12:34pm
I was fascinated by Peter's homage to Zithromax, because I have a sinus infection too. I could probably get myself some of this Zithromax stuff, but I want to be responsible and do my part to diminish the frivolous use of antibiotics. Also, who wants to deal with antibiotic side-effects if the medicine isn't going to do any good?
You won't get much good conversation out of me until this problem is solved, so let's think this one through together. Are there any sure symptoms of a bacterial as opposed to a viral infection?
Don't tell me to go to my doctor--I'm in Istanbul, the doctor will dose me up with antibiotics, no matter what symptoms I have. It's up to me to be responsible here.
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Comments:
Sep '10
Re: Sunday Morning Debate: Viral or Bacterial?
I can confirm from personal experience (I have a head cold now) that these two really work to alleviate congestion. Especially the oxymetolazone spray -- wow. I just discovered that because Vicks is packaging free samples with Nyquil. Whoever invented that deserves some kind of medical science award and a nice second home in the tropics.
Apr '11
Re: Sunday Morning Debate: Viral or Bacterial?
You don't have to be in Istanbul. Try breathing exercises.
Nov '11
Re: Sunday Morning Debate: Viral or Bacterial?
Claire Berlinski, Ed.: Was that a single conservative massage therapist? Maybe I have a fever but that really sounds nice.
. · Jan 15 at 12:22pm
I wouldn't say "single" exactly; "widowed grandmother" would be more accurate. But if you're ever in the D.C. area....and massage therapy is helpful for those suffering from the primary election blues (assuming the therapist shuts up), though not as good as a couple of good, stiff drinks.
Jan '12
Re: Sunday Morning Debate: Viral or Bacterial?
If you suffer repeated sinus infections (or this is the start of repeated sinus infections), consider the possibility you have a dental problem where an abscessed tooth is leaking into a sinus rather than into the oral cavity. This would particularly be the case if you suffered a dental injury years before.
Picture a "gum bubble" (dentist talk for a zit on your gum) leaking infection into the mouth, requiring an dental apico & root-canal procedure.
Now instead of a "gum bubble" picture a "sinus bubble" where the infection is leaking into a sinus cavity, infecting the sinus with bacteria.
Your sinus infection may clear but it may then reoccur because the underlying cause remains untreated.
Feb '11
Re: Sunday Morning Debate: Viral or Bacterial?
Claire,
Here is the deal. If you have a thick yellow or greenish nasal discharge with post nasal drip and facial pain, it suggests that an original viral URI has become secondarily infected. This is esp true if the symptoms are ongoing say over a week or so. In that case you would be appropriately treated with antibiotics. I tend to favor zithromax for a variety of reasons. There is less resistance than with amoxicillin or even Augmentin (amoxicillin with an agent added to suppress resistance based on beta lactamase) and it is generally well tolerated and effective. Moreover, it is bacteriostatic versus bacteriocidal (meaning it suppresses the bacteria versus actually killing them) thereby allowing your own immune system to function in this process and develop antibodies. If such is the case you would benefit from seeing the doctor for a z-pak (zithromax).
You ALSO need pseudoephedrine (Sudafed or generic) and ibuprofen. The first opens up your nasal passages and dries them out somewhat (they are too "wet" right now) and the latter acts as an antiinflammatory to decrease your discomfort secondary to inflammation. Let me know if you need any other assistance.
(Wife of Snowbird, MSN, FNP)
Edited on January 16, 2012 at 4:31amMay '10
Re: Sunday Morning Debate: Viral or Bacterial?
I hate to bring this up, Claire, but if you are having frequent sinus infections, the cats may be your problem. You do have several, don't you? There was an article recently about cats and adult allergies and asthma, particularly if the cats are permitted to sleep in the bedroom. Here is the abstract. I don't immediately have access to the full article, but will see if I can get it through the med school. One thing that I've said before may be operative: Epidemiology is largely junk science. This recent study may be proved wrong later. Still possibly worth a look.
BTW, I said I hate to bring it up because I have two that sleep with me and a third that visits frequently, and would hate to be told they can't.
DocJay, are you familiar with this? It's a comprehensive look at sinusitis with treatment guidelines. In case the link is wrong, here's the ref: Otolaryngol Head Neck Surg. 2004 Jan;130(1 Suppl):1-45.
Feb '11
Re: Sunday Morning Debate: Viral or Bacterial?
I haven't read all the comments above (and because of time constraints won't) but I really hope that you're posting this just to get another post up on Rico, not because you're actually going to sift through these scores of comments for actual action items that you hope to implement. There's some terrible (but popular) advice up there. Just one example: The color of your snot hasn't been used to differentiate between bacterial and viral infections for over a generation. Viruses can cause green snot too, but that info hasn't penetrated the public yet.
If you're really crowdsourcing your sinus infection treatment, then I despair.
But if so, check out what I wrote about it a couple of years ago. Scroll down to the acute sinusitis bit. Bottom line: try nasal decongestants around the clock for a week before hitting the antibiotics. If you can tolerate pseudoephedrine (Sudafed), take 60 mg four times a day until your symptoms resolve. It makes some people too jittery.
Feel better.
May '10
Re: Sunday Morning Debate: Viral or Bacterial?
@Doctor Bean,
Spot on. I was going to address the "green snot" issue, too, but just don't have the energy. I really need to get home...
But one last: I suggested as much before, but Zithromax doesn't work very well. Macrolides have a mild anti-inflammatory effect and that can help relieve some symptoms. But so can Motrin. An actual decongestant, tea, chicken soup, rest, fluids, all help. The clinical trials on treatment of acute sinusitis are generally poorly done. This is a disease that is seldom caused by bacteria (estimated 0.5-2% of sinusitis is bacterial), with clear identification of the causative agent of the disease nearly impossible (see note about needles in the face, above), thus making endpoints unmeasurable, so most studies rely on "clinical cure" as a proxy endpoint. The problem with that is that most cases clear up on their own. Given that history, nearly all drugs appear equally effective. Emphasis on appear.
Bottom line, Claire, you've only had symptoms for 3 days. See how you feel a week from now. If symptoms are worse, seek further treatment. Else, just tough it out. Someone suggested a toddy. Sounds good to me.
Edited on January 16, 2012 at 1:15amDec '10
Re: Sunday Morning Debate: Viral or Bacterial?
Watch the pseudoephedrine. It isn't just jitters for some of us, it's heart palpitations. Bad stuff. And the nasal spray decongestants are recommended for no more than three days for a reason. They cause a rebound effect. I pretty much limit their use to when I have to fly or if I'm desperately in need of sleep.
I'm not a doctor, but I've seen at least a few for this and I've got a couple sibs who are and the treatment trifecta commonly recommended by all, up until you've got to use antibiotics, is:
Mucinex, which is 12-hour time-released guifenesin, to make the mucous slippery,
Ibuprofen to reduce inflammation in the nasal passages and reduce sinus headache pain. This is especially important if you can't use pseudoephedrine.
Humidity. Lots of it.
Jul '10
Re: Sunday Morning Debate: Viral or Bacterial?
Back some time ago (our doctor made house calls) he prescribed a very simple treatment (pre-Neti pot, I presume): 1 teaspoon sea salt/quart of boiled water (15 min, minimum) placed in a sterilized jar. When cool, we were to wash our hands thoroughly, then place some water in our hand and inhale it, spitting out the water. This was repeated a few times. He also said not to use the prepared water more than 2 days; after that we were to make a fresh batch.
It really works. Rather nasty to perform, but one couldn't argue with the results. Note: He wasn't keen on using those small bulb syringes as he didn't think they could be cleaned well enough. This may be the case with the pots.
Jul '11
Re: Sunday Morning Debate: Viral or Bacterial?
Caryn, yes I am, thank you. Doctor Bean, my brother from So Cal. I shall steal your material, post on my website and claim it as my own.....evil laugh.
Re: Sunday Morning Debate: Viral or Bacterial?
I knew that, and it's one of the things I keep telling people here, just as I keep telling them that antibiotics will not necessarily cure everything.
I'm touched that my sinuses have prompted this much discussion, some even skirting the edges of a code-of-conduct warning.
Is there a conservative position at which we're arrived?
Feb '11
Re: Sunday Morning Debate: Viral or Bacterial?
Caryn, I think I love you, but in a professional way that would not offend my wife.
DocJay, you evil genius, write your own blog posts! (We really need to meet in person some time.)
Claire, our ailing queen: Yes, the conservative position is to minimize antibiotic use and to cling to the null hypothesis. Most treatments have no effect on most diseases and to believe otherwise for a specific disease and a specific treatment should require some data, ideally from a randomized placebo-controlled trial. That data for antibiotics and sinusitis is pretty shaky. I hope very much that you recover quickly and completely.
Aug '10
Re: Sunday Morning Debate: Viral or Bacterial?
Claire Berlinski, Ed.
Israel P.: Sinuses can be ugly. I almost died from a FESS a few years ago. Eventually they redid it through the roof of my mouth. · Jan 15 at 9:39am
Edited on Jan 15 at 09:39 am
I had not yet thought to worry that this might be ... fatal.
Wouldn't that be an irony. All those warnings to be careful out there and in the end it's my sinuses that do me in. · Jan 15 at 12:09pm
Sinus bacteria are all extremist terrorists. FACT!
Aug '10
Re: Sunday Morning Debate: Viral or Bacterial?
That's a scary name.
Sep '11
Re: Sunday Morning Debate: Viral or Bacterial?
People who get a bad reaction to ephedrine/pseudoephedrine report quite scary symmptoms of being spaced out and very depressed. I know, because my partner can't take it for that reason. Nowadays, most cold remedies contain it. In the Netherlands, where just about anything goes, you cannot buy cold remedies over the counter for that reason. So a stinking cold ruined a weekend in Amsterdam. Given my condition, I didn't fancy hash cookies, but I did think of asking a nice doctor to put me down.