I don't want to be on the sinus infection roller coaster.

December 10, 2010 2:05 PM

I don't want to end up on the sinus infection roller coaster. I'm curious about people's experiences with antibiotics.

I've been miserably fatigued for four months. Only in the last month have I started getting obviously, repeatedly sick. A lot of that has been sinus pressure, brain fog, and unquenchable thirst (doc ran a bunch of tests including glucose, calcium, and many more--all the thirst stuff and more stuff besides, and found nothing). The doc doesn't seem particularly interested in the fatigue or the thirst because all my tests are normal, but after a couple weeks of being obviously continuously sick, she felt that antibiotics were a reasonable next step. This is day three, and I feel... different, but I suspect I have a long way to go.

I read on some questionable website that antibiotics should continue for weeks to make sure the sinus infection doesn't come back with resistance to whatever antibiotic was used.

I'm wondering if I've been experiencing a sinus infection for months. I read on another questionable website that fatigue is a better indicator of a sinus infection than sinus pressure per se. I only started feeling sinus pressure in the last three weeks or so.

So, question--this course of antibiotics is only for ten days--you are not my doctor, but is that enough, chronic sinus infection veterans? I don't like being on antibiotics (I'm guzzling multiple brands of probiotics), but I have been utterly miserable for months, and my doc refuses to connect the dots. Are you a sinus infection veteran? Is there a way to minimize chances of relapse? I'm neti-potting, but it doesn't seem to be doing much. I've felt stunningly better, a million bucks, for 1-3 days at a time, but then fatigue comes back full force for weeks. I know what I'm missing and I really want to get it back permanently and not be dealing with this for many more months. What are some conversations I should have with my doctor?

*I also went to an ENT, stupidly when my symptoms were at lower ebb (but I had enough energy to get over there), and she said my sinuses were inflamed, maybe post-viral, but she didn't seem too concerned, either.

posted by zeek321 to health & fitness (33 answers total)

(I saw the ENT when I started having sinus pressure, but before I started getting repeatedly obviously sick--fever, cough, yellow mucus, etc.)
posted by zeek321 at 2:09 PM on December 10, 2010

Ok.

1. I can't believe doctors don't do this regularly anymore (although they [expletive] well ought to based on the antibiotic resistance that's going to kill us all at some point, but anyway) - your ENT should be able to, instead of plain GUESSING - do a culture of the junk in your nose to figure out if you actually have a bacterial infection in there! It usually takes a couple days to wait for the results, 'cause stuff has to grow in the petri dish to prove it's there, but that's the way to go right there.

If you do have a bacterial infection

2. antibiotics for 10 days is usually fine, if the antibiotics are going to work for you. A lot of the older antibiotics don't work anymore due to bacterial resistance. And some of them I think are just crap (like the Zithromax 'z-pack') but that's just my personal anecdata. Take ALL of them.

Hopefully you will be free of the pestilence at that point.

If you do not have a bacterial infection, there's a bunch of things that could be bugging you, like a viral infection (I have no anecdoatl experience with virual sinus infections that stay strictly up there for that long, but they are out there), allergy, non-allergic rhinitis. Probably some other stuff they could cat-scan you for, I imagine.
posted by bitterkitten at 2:12 PM on December 10, 2010 [1 favorite]

Er, I meant take all of the prescribed doses of antibiotics you are prescribed if they appear to be working, that is. Not every one under the sun for no reason. : )
posted by bitterkitten at 2:14 PM on December 10, 2010

I suffer from one or two sinus infections every year. Antibiotics are marvelous.

In my experience, the infection will be 99% gone within 48 hours of starting the antibiotics. (It's important to finish all 10 days, though, at the risk of developing resistant bacteria). You'll have very fickle digestion for a while, but it's absolutely worth it to stop the suffering.

Your symptoms kind of sound like a sinus infection. Did you have any fever? Do your eyes feel painfully dry? When you blow your nose, is the result unusually think and yellow?
posted by qxntpqbbbqxl at 2:16 PM on December 10, 2010

You could try this stuff. Probably wouldn't do any harm, and really worked on the hubby's chronic sinus infection.
posted by Go Banana at 2:17 PM on December 10, 2010

This is antibiotics day three. Over the first 24 hours something seemed to change, but I don't feel magically much, much better, which prompted this question. I know to take the full course, no matter what.

I did have a fever and thick yellow mucus. That has disappeared as of today. But I still have sinus pressure, fatigue, clear runny nose ever hour or two, and a productive cough--I'm still coughing up thick stuff that has a weird taste/smell.
posted by zeek321 at 2:28 PM on December 10, 2010

I'm a doctor. I encourage you to complete the 10 days course of the antibiotic. Whatever antibiotic is used, the success rate is about 80%, so there's a 20% chance you'll need re-treatment with a different antibiotic. The top three (in no particular order) are azithromycin, trim-sulfa (Septra/Bactrim), and amoxicillin-clavulanate (Augmentin). If you are prescribed Augmentin, I strongly recommend eating a live-culture yogurt while you're on it, else you might get diarrhea.

Chronic sinusitis is common. If you fail two courses of antibiotic you should get a CT and/or a visit to an ENT specialist.

The main thing I came here to say, though, is: use a neti pot.
posted by neuron at 2:38 PM on December 10, 2010 [6 favorites]

Humidify your bedroom, keep it a shrine to cleanliness, no TV to gather dust, minimal furniture, no drapes (or at least wash them monthly) vacuum every day. No feather pillows, wash and change sheets weekly, absolutely NO PETS in bed. Make sure the humidifier is meticulously cleansed and keep up the warm salt water (sea salt and tap water) neti pot **religiously**. Line inside of nose with FRESH Vaseline before retiring at night, don't just dive into the jar with dirty fingers, use q tips and toss them with each nostril to avoid cross contamination. Get a script for a steroid based nasal spray and use it as directed, this keeps your sinus passages open, hence drainage of the nasty gross stuff. Good luck and I hope you feel better!
posted by ~Sushma~ at 2:38 PM on December 10, 2010 [5 favorites]

your ENT should be able to, instead of plain GUESSING - do a culture of the junk in your nose to figure out if you actually have a bacterial infection in there!

Everyone has staph living in their noses. The only way to run conclusive cultures for sinus infections, in the absence of prurulent material that is actually oozing into the post-nasal area of the throat, is to run a needle into the maxillary sinuses. This involves piercing the face, so ENTs don't do it.

If you can invent a magical device that will help ENTs extract material from the maxillary and frontal sinuses without running a big ol' needle in through the face, every ENT on earth will praise your name everlastingly.

This is one of the tricky things about sinus infections--they're not like, say, throat infections where you can swab for a culture. The sinuses are hard to get at.


Okay, moving on from that.

A) The antibiotics should help you, if you finish the course. If the sinus infection comes back, you will need a different antibiotic and a longer course. If your primary care doctor won't give you a longer course (should be at least twice as long as the standard course), you need to go to an ENT.

B) If you wind up having chronic sinus infections, you should get imaging sooner rather than later, because imaging is the best way to see what's going on. In-office endoscopy is pretty much useless if you have an infection in the maxillary or frontal sinuses.


If you like the neti pot, keep using the neti pot. If you are not currently using a neti pot, consider using a pressure bottle instead--it provides more force than the neti pot. A nasal irrigator is something else to consider.

Think about adding a drop (a drop!) of a dilute tincture of wild oregano oil to your nasal irrigation. I find it works beautifully, but other people find it annoying. (Don't put even a drop of pure wild oregano oil in even as much as 16 oz. of nasal irrigation solution, because that will be too much.)

Seconding ~Shushma~'s recommendations, except to add that you should probably change your pillow cases each night, and wash your pillow ticking (the inside zippered cases) each week. In hot water, because cool water doesn't kill dust mites. Wash your face with hot water right before you go to bed.


I have been the plaything of sinus infections all my life, but I hit bottom this year--I've been on an exciting parade of antibiotics since January. Next week, surgery! HOORAY!
posted by Sidhedevil at 2:57 PM on December 10, 2010 [4 favorites]

I read on some questionable website that antibiotics should continue for weeks to make sure the sinus infection doesn't come back with resistance to whatever antibiotic was used.

That's gold-standard treatment for chronic sinus infections, yes. (That website might or might not be questionable, but that particular bit of information is absolutely accurate for chronic sinus infection.)

I mean, what we're hoping is that you don't have a chronic sinus infection, and that your current course of antibiotics will fix this. But if it doesn't respond to this course of antibiotics, a double course of the next antibiotic might be indicated.

I'm wondering if I've been experiencing a sinus infection for months. I read on another questionable website that fatigue is a better indicator of a sinus infection than sinus pressure per se.

Fatigue/thirst/interrupted sleep are all symptoms of sinus infections, particularly of the maxillary sinuses. So again, can't vouch for the website as a whole, but the unexplained fatigue thing is real (per my functional medicine specialist and my otolaryngologist).

What did your sedimentation rate look like on your bloodwork? Because that will often reflect an infection.
posted by Sidhedevil at 3:03 PM on December 10, 2010

Sid -

hrmmmmmmmmmmm! So if that's true, tell me why my ENT said they could do that the last time I went in there.... and then supposedly did a culture by giving me some minor local anaesthetic, stuck one of those sticks up my nose, followed by me smacking my head incredulously and going "WTF, why don't they do this all the time?" Then a few days later he called and said "nope, nothing doing." Hooray for... a culture that proved nothing?

Is he full o bull? Cause if that's true i'm bummed. I was so excited that there'd be no more guessing games at the (my particular) doc's office. "Is it a sinus infection? Is it not?" I mean, sure, getting cat scanned all the time would be fine if it was harmless. Not to mention they have one of those machines in that office.
posted by bitterkitten at 3:19 PM on December 10, 2010

bitterkitten, if there was stuff actually oozing out of your maxillary or ethmoid sinuses, your doc could culture that, I suppose? But that wouldn't rule out infections in the frontal or sphenoidal sinuses, so.

My own sinus infections have been in the frontal and maxillary sinuses, and you can't get to the frontals at all without poking a big ol' needle through the face, which my first ENT said was "barbaric".

I would think about finding a new ENT, to be honest. Nasal swabs aren't particularly determinative diagnostics, according to either my first ENT or my current guy.
posted by Sidhedevil at 3:23 PM on December 10, 2010

bitterkitten, this explains why nasal swabs aren't all that determinative, and why they don't necessarily correlate to the results obtained by sinus punctures and imaging.
posted by Sidhedevil at 3:27 PM on December 10, 2010

The doc doesn't seem particularly interested in the fatigue or the thirst because all my tests are normal,

When I had symptoms very much like yours (and not for the first time,) my doc said "instead of me guessing and prescribing antibiotics, I'm sending you to an asthma/allergy practice, since they have expertise in chronic sinus infection."

Stick with the antibiotics. Me, I wound up having to go through multiple rounds of antibiotics and prednisone before I finally kicked the chronic infection...but then HOLY CRAP I got my life back and realized how accustomed I'd become to a certain level of sickness.

And now I see the asthma/allergy people periodically for maintenance checkups, and squirt salt water up my nose every morning, and use some prescription nose sprays to keep the inflammation at bay.

I saw an ENT at one point as well, based on a recommendation from a friend. His only solution was surgical, he inflated the benefit and downplayed the side effects, and his attitude was basically that I'd eventually get desperate enough for it. Nofuckingthankyou.
posted by desuetude at 3:39 PM on December 10, 2010

What did your sedimentation rate look like on your bloodwork? Because that will often reflect an infection.

That would be interesting, because I got my bloodwork before any symptoms besides fatigue. Any idea what that would be called on my test results? They did a bunch of immune system stuff. I do know that every single value was dead middle in its reference range. That's good of course, but sigh.
posted by zeek321 at 4:15 PM on December 10, 2010

ESR (erythrocyte sedimentation rate) would be the relevant value as a marker of inflammation, which sinus infections are.
posted by Sidhedevil at 4:17 PM on December 10, 2010

A neti pot side-question: I have a little point of pain left of my nose inside my cheekbone that's been coming and going. Maxillary sinus? How do I tilt my head to get salt solution in there?
posted by zeek321 at 4:20 PM on December 10, 2010

ESR (erythrocyte sedimentation rate) would be the relevant value as a marker of inflammation, which sinus infections are.

Interestingly she didn't order that, but maybe she had her doctor reasons. This was all the blood and immune system-esque stuff I could find. I will reiterate that I realize none of you are my doctor or a substitute for a doctor.

Test Name Result Abnormal Reference Range
------------------------- --------------- -------- ---------------
WHITE BLOOD CELL COUNT 6.6 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.03 4.20-5.80 Million/uL
HEMOGLOBIN 15.6 13.2-17.1 g/dL
HEMATOCRIT 46.2 38.5-50.0 %
MCV 91.7 80.0-100.0 fL
MCH 30.9 27.0-33.0 pg
MCHC 33.7 32.0-36.0 g/dL
RDW 13.7 11.0-15.0 %
PLATELET COUNT 247 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 4132 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1769 850-3900 cells/uL
ABSOLUTE MONOCYTES 548 200-950 cells/uL
ABSOLUTE EOSINOPHILS 119 15-500 cells/uL
ABSOLUTE BASOPHILS 33 0-200 cells/uL
NEUTROPHILS 62.6 %
LYMPHOCYTES 26.8 %
MONOCYTES 8.3 %
EOSINOPHILS 1.8 %
BASOPHILS 0.5 %
posted by zeek321 at 4:25 PM on December 10, 2010

Sed rate's aren't very specific, anyways.

I kind of wanted to chime in about the length of antibiotic treatment, because there could be some confusion with what's been said.

Sometimes, people start taking antibiotics, then the antiobiotics kill off a lot of the pathogens, and the people go, "Oh, I'm better, i can stop taking these antibiotics," which is a bad idea, because some pathogens are still around, and you end up selecting for ones that are drug resistant. So that's why people say to stay on the antibiotics for however long.

But how long that is depends on the antibiotic involved. So you don't have to be on antibiotics for months. Just stay on the antibiotic for as long as the doctor told you to. Don't stop taking them half-way through if you feel better. Finish the bottle.

Also wanted to chime in regarding neti pots. Neti pots are great for symptoms, but they're not about cure. If you use a neti pot, use it to feel better, and stop using it when you stop needing it. Long term neti pot use has been associated with recurrent infections. Here's my source-- sorry, you'll need to register, but at least it's free.
posted by nathan v at 4:26 PM on December 10, 2010

A few addenda to some of the really good advice you're getting:

(1) You can use the neti pot several times a day until your sinuses are cleared up. This means as many as four or five.
(2) Nix to the vaseline. Use triple antibiotic and Q-tips instead.
(3) Keep a humidifier going at least half the day. The easiest thing to do is use one in your bedroom, but if you really want to go crazy, you can buy a little one, like this, to put on your desk at work.
(4) Don't let any of the orifices on your head get dry; this only invites more irritation, which can quickly turn into another sinus infection.

To prevent dryness, use:

a) the antibiotic on your nose and lips.
b) a dab of ear wax removal fluid in your canals at the maintenance level; first time you use it, however, you can use the full amount, along with the "bulb" to help get the pressure down in your ears.
c). a saline eyewash solution and "eye cup" if your eyes get dry.

Do this all winter, and guaranteed you can stave off recurrences for years to come.
posted by Violet Blue at 5:03 PM on December 10, 2010 [1 favorite]

A neti pot side-question: I have a little point of pain left of my nose inside my cheekbone that's been coming and going. Maxillary sinus? How do I tilt my head to get salt solution in there?

You can't, really. Hot compresses are your friends for that kind of thing.
posted by Sidhedevil at 5:06 PM on December 10, 2010

10-14 days of antibiotics is PLENTY. If you take any more than that, you're ostensibly raping your body of all the good bacteria and flora that live in your gut and intestines and that can leave to some other really rotten side effects, which you're obviously aware of 'cause you're dosing up on all those great probiotics.

What antibiotic are you on? I've had chronic sinus infections for years and after coughing up red mucus from my dumb nose for a week my doctor finally decided to x-ray my face and determined I have some kind of blockage in each of my nasal passageways that's just never allowing me to kick the infection I've seriously had since junior year of high school. (aka 6 years ago) Initially I was put on Avelox but I started getting some of the primary allergic reactions (ie shakes, numbness) so that had to be nixed in favor of Augmentin (amoxicillin and clavulanate potassium) which is super awesome 'cause there are no side effects (at least for me). I have to eat copious amounts of fresh yogurt and acidopholus to re-right my body's natural equilibrium, but hey! No more red nose Patronus Charms!
posted by patronuscharms at 5:09 PM on December 10, 2010

I have had sinus problems in the past and agree with the good advice above about antibiotics, neti etc. The thing that was hardest for me though but VERY important is getting enough rest & staying hydrated. Drink, sleep, pee. drink, sleep, pee. Drink, sleep, pee until you feel like that is all you have ever done. Do not try to go to the office, help people move, etc etc. Feel better soon!
posted by pointystick at 5:36 PM on December 10, 2010

10-14 days of antibiotics is PLENTY.

Not necessarily. Several years ago I developed a sinus infection on Thanksgiving Day. I went to the doctor the following Monday, and she told me it was viral and to go home and ride it out. A week later, I still wasn't better. I was coughing, wheezing, had green stuff all over, fever, headache, etc. I went back and she still didn't give me anything. A few more weeks went by. I would get a little better, then get worse again, then better, then worse. I went back a couple more times and was finally told I had allergy induced asthma. Ok, fine. I made an appointment with an allergist. When I went to see him, he took one look at me and told me I had a sinus infection and asked how long I had had it. At this point it was Spring Break, so we're talking 4 months. He prescribed 6 weeks worth of antibiotics and told me to finish them ALL. He then proceeded to get on the phone and rip my other doc a new one.
posted by ValkoSipuliSuola at 6:54 PM on December 10, 2010

Anecdata: I've had a hell of a time with my sinuses all my life. Recently I got a quite remarkable infection where my face swelled up and I looked like a chipmunk. It took two courses of (different) antibiotics to get rid of it, plus a Neilmed pressure-rinse system and a steroidal spray.

The weird thing is that I have been breathing comfortably since then (a couple months) through both nostrils. This hasn't been true since high school and I am 52 years old. My partner loves the decrease in snoring, I love the free breathing.

My sister had surgery to fix -her- sinuses, and it didn't work.

Therefore: I would not give up too quickly on antibiotics. For sure, *finish the whole prescription* but it appears to me that even the standard course of Keflex might not finish the job comprehensively.
posted by jet_silver at 8:11 PM on December 10, 2010

10-14 days of antibiotics is PLENTY.

No, it really isn't. It would be great if it were, but when you have resistant infections, you need to take antibiotics for as long as the doctor tells you to.
posted by Sidhedevil at 8:34 PM on December 10, 2010

I mean, sometimes two weeks is plenty. Sometimes six weeks is plenty. Sometimes three months is plenty. The person who knows the answer to this is the doctor who is following the course of the infection, not random people on the internets.
posted by Sidhedevil at 8:36 PM on December 10, 2010 [2 favorites]

I'm taking Biaxin/Clarithromycin. I may or may not have allergies to penicillin, quinolones, and sulfa stuff. Long story.
posted by zeek321 at 9:07 PM on December 10, 2010

Honestly, in my experience... If I have to take more than 2.5 weeks of antibiotics, I'm on the wrong kind. That's what happened to me when I was first diagnosed with chronic sinusitis -- the ER doctors were like OH HAI OKAY SURE and prescribed some super crappy antibiotic for a month that just never got rid of what I had. My GP finally was like, "WTF have you been on? You need the hardcore stuff" and only prescribed me 10 days because the stuff works so incredibly well. So that's just my experience and the educated opinion of my GP. But! Sidhe is right. It all depends on you and your doctor's diagnosis.
posted by patronuscharms at 9:41 PM on December 10, 2010

Sometimes when I take antibiotics for sinus infections the first 10-day antibiotic doesn't work. In that case, they need to immediately put me on a second course of a different/stronger antibiotic. So make sure you take all your antibiotics, and if you are still sick at all at the end, tell them they didn't work and that they need to put you on a second course of stronger antibiotics.

Another thing that I've found really helps clear up sinus infections and prevent their recurrence is using a Neti Pot sinus rinse. You still need an antibiotic to kill off the infection, but the sinus rinse will help clear the infected gunk out. Then if you keep using it at night, it will wash out some of the crap (dust, pollen, crystallized snot from low humidity, etc.) that accumulates in your sinuses during the day and that can clog things up and encourage infections.
posted by Jacqueline at 8:07 AM on December 11, 2010

A couple other things that have cut down the frequency of my sinus infections a lot, by cutting back my allergies:

1) Getting allergen-blocking pillow covers and other bedding covers

2) Dusting and vacuuming much more frequently than before
posted by Jacqueline at 8:10 AM on December 11, 2010

As far as probiotics go, have you tried Florastor? IANAD but I think it's supposed to be better than most. For the second year in a row, I was prescribed amoxicillin for a chronic cough and other symptoms that my ENT said could be sinuses/post-nasal drip etc. While I had no problems with amoxicillin last year, this time around they gave me a serious *ahem* bout of diarrhea for over a week, and lower back pain. I thought I was sick from a stomach virus and went to my PCP, who ran tests and told me to stop taking the antibiotics because they were killing off the good bacteria in my gut. After stopping them didn't make me feel better on its own, I did some research and found that intestinal complications from taking antibiotics aren't unusual. I started taking Florastor and was back to normal in a few days or so.

So, long story short, if you do take anitbiotics, ask about taking a strong probiotic at the same time so that you don't swap one problem for another. Good luck!
posted by luckyveronica at 12:02 PM on December 11, 2010

10-14 days of antibiotics is PLENTY.

Oh for pete's sake, there are plenty of treatment courses that are longer than 10-14 days. Different people and different infections react differently to different antibiotics. Your doctor's educated opinion was regarding YOUR sinusitis -- it's not a cut-and-dried thing to treat.
posted by desuetude at 12:28 PM on December 11, 2010