By Kathryn Galbraith, MD
With the growing costs of healthcare and the huge amount of information and testing available to us, it can be quite difficult to know what tests and treatments are most likely to be beneficial, are least likely to harm, and are most cost-effective. Enter an initiative known as “Choosing Wisely.” This program is part of a multi-year effort of the ABIM (American Board of Internal Medicine) Foundation, along with its partners including Consumer Reports, to help physicians be better stewards of our finite health care resources. Choosing Wisely aims to promote conversations between doctors and patients and to help patients choose care that is supported by evidence, does not duplicate other tests or procedures already received, is free from harm, and is truly necessary. In an effort to do this, national organizations representing medical specialists asked their providers to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. The resulting lists of “Things Providers and Patients Should Question” is meant to spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments, according to the Choosing Wisely website. This article is the third in a series of articles highlighting some of the commonly requested treatments in medicine and the recommendations for their safe and effective use.
With the start of spring and summer allergy season and the sharing of new viruses as we emerge from our winter indoor “hibernation” to begin our outdoor social activities, sinus problems are on the rise. While it is very tempting to go to the doctor to request antibiotics for sinus congestion and inflammation, termed “sinusitis,” this is often not necessary. According to the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American Academy of Family Physicians (AAFP), antibiotics should not be routinely prescribed for acute mild to moderate sinusitis, unless the symptoms last 7 or more days or the symptoms worsen after initial improvement.
The sinuses are air-filled spaces in the skull that are lined by the same tissue that lines the nasal passages. These tissues can become swollen and inflamed, blocking the drainage of the sinuses, and causing nasal congestion, headache, facial pressure, and tooth pain. The cause of this inflammation is most commonly viral, but can also be allergic, irritant or, least commonly, bacterial. Because antibiotics only kill bacteria, they are not recommended in most cases of sinusitis. The fact is that most cases of sinusitis—even many of those caused by bacteria—resolve on their own within about a week.
Apart from being largely unhelpful, antibiotics can be harmful. According to the Choosing Wisely website, about one out of every four people who takes antibiotics will have side effects such as dizziness, stomach or digestive problems and rashes. Yeast infections of the mouth or vagina can also be caused by antibiotics. In rare cases, a severe reaction can occur that can be life-threatening. In addition, the overuse of antibiotics sets up the potential for the bacteria to become resistant to them, meaning that when the antibiotics are needed in the future they will not work.
Treating sinusitis with antibiotics can also be expensive. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs, according to the Choosing Wisely website.
Antibiotics do have their place, however. According to the AAAAI, antibiotics may be considered if symptoms have lasted longer than 10 days (the AAFP suggests longer than 7 days), or if symptoms have begun to improve and then suddenly worsen. Severe symptoms may warrant the use of antibiotics, as well, such as severe pain and tenderness around the nose and eyes, signs of a skin infection including a red and hot rash that spreads rapidly, or a fever over 102 degrees F. If antibiotics are needed, amoxicillin is the most effective and least expensive one to use, as long as there is no known allergy to the medicine.
So what should you do in the initial days of sinus pain and pressure?
First, rest. Your body needs time to recover and fight any infection.
Drinking warm liquids like tea keeps you hydrated and helps to loosen mucus, allowing it to drain faster. Breathing warm, moist air such as in a steamy shower also loosens mucus.
Rinsing your nose with saline nasal sprays or washes can soothe irritated tissue and remove any irritants or allergens trapped on the nasal or sinus tissues. Follow the directions on the label of these products.
Over-the-counter medications can help to relieve sinusitis symptoms as well, but use them with caution. Tylenol or Non-steroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen and naproxen help relieve the pain and pressure in the head and sinuses. Generic pseudoephedrine (brand name Sudafed) can relieve congestion; sign for this at your pharmacy window. Steroid nasal sprays like Flonase or Nasonex can also be beneficial and can be used long-term, unlike Afrin or similar “decongestant” nasal sprays that must be stopped after 3 days.
Talk to your doctor about which options might be best for you.
For more information, talk to your doctor or visit www.choosingwisely.org.