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Sinus Infections: 90 To 98% Are Caused By Viruses, Guidelines Say

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Have a sinus infection? Antibiotics shouldn't be your go-to treatment, according to a new set of guidelines from the Infectious Diseases Society of America. Turns out, anywhere from 90 to 98 percent of the infections aren't caused by bacteria, meaning antibiotics won't work.

"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,'" guidelines panel chair Dr. Anthony W. Chow, MD, a professor emeritus of infectious diseases at the University of British Columbia, Vancouver, explained in a statement.

The panel included experts from the Centers for Disease Control and Prevention, the American College of Physicians and the Society of Academic Medicine. The guidelines will be published in the journal Clinical Infectious Diseases.

But if the sinus infection is actually caused by a virus, taking antibiotics wouldn't help at all and could even increase antibiotic resistance, he added.

According to the Infectious Diseases Society of America, sinus infections -- also known as acute rhinosinusitis -- are diagnosed in nearly one out of every seven people each year, and are the No. 5 reason people are prescribed antibiotics. They are caused by nasal and sinus passage inflammation, and most often occur after a person has experienced a cold or cold-like sickness.

Symptoms of a sinus infection include headache, sore throat, stuffed-up nose and/or a runny nose, bad breath, fatigue, postnasal drip, cough and even fever, according to the Centers for Disease Control and Prevention.

The CDC notes on its page on sinus infections that people should see a doctor if they have symptoms lasting more than 10 days, or regular OTC medicines aren't helping at all. Kids who have a fever of 100.4 degrees Fahrenheit or higher should also see a doctor.

The new guidelines urge doctors to treat sinus infections by prescribing amoxicillin-clavulanate to patients instead of just amoxicillin (which is how sinus infections are currently treated) in order to help overcome antibiotic resistance. The guidelines also urge doctors not to use other commonly prescribed antibiotics, such as clarithromycin, azithromycin and trimethoprim-sulfamethoxazole because of antibiotic resistance.

The guidelines also include ways for doctors to tell the difference between virus-caused sinus infections and bacteria-caused sinus infections. A bacteria-caused sinus infection -- which deserves treatment with antibiotics -- is one that has symptoms lasting longer than 10 days without getting any better. Other signs include when severe symptoms last for three or four consecutive days, or when the symptoms get worse.

The guidelines also urge doctors to treat with antibiotics for just five to seven days, rather than the previously recommended 10 to 14 days.

Recently, the Journal of the American Medical Association published a study showing that antibiotics don't work most of the time against sinus infections, Reuters reported.

"Rather than give everybody an antibiotic hoping to find the ones with bacteria, our findings would suggest refraining from antibiotics and doing what we call watchful waiting," study researcher Dr. Jane Garbutt, of the Washington University School of Medicine in St. Louis, told Reuters.

Just last week, World Health Organization Director General Dr. Margaret Chan spoke at a conference, explaining how antibiotic resistance is making diseases more difficult to treat, ABC News reported.

"We are losing our first-line antimicrobials," ABC News reported Chan saying. "Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units."

CORRECTION: A previous version of this article misstated the percentage of infections not caused by bacteria.

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