2 month long sinus infection won't go away

January 16, 2016 4:57 PM

I got the 3rd ever sinus infection in my life in mid-November. I finally went to a doctor about it in mid-December. I'm now on my third round of antibiotics to deal with it, and it won't go away. Help!

The infection was glowing yellow, noxious-smelling, burning non-stop goo when I went to the doctor the first time. I was given azithromycin 250mg 6-pill, 5 day course, that supposedly works as a 10 day course. Took that, things got a bit better. The goo stopped being yellow, but never went away. At around the 15 day point I went back and got a second round, took that, didn't change much of what was going on. This last Tuesday I went back and got a third round and the first thing the infection did was turn a horrible yellow again. While the yellow has gone away (again), it's still noxious smelling and isn't going away, and I have one pill left.

The doctor told me to get nasal saline spray and to use it "10 times a day", but I've been using it a lot more than that, basically every time I blow my nose (which is sometimes multiple times an hour) I spray it afterward.

I really really want this to end. What am I doing wrong? What other home treatments can I use to help this process? What words do I need to use with my doctor to communicate clearly that the treatment he has been giving me is not working? This has gone from merely annoying to truly worrying, and I just want to have normal snot that doesn't stink of rot or make me gag when it drips down my throat.

Other pertinent information is that I'm allergic to the -cillin based antibiotics.

posted by hippybear to Health & Fitness (38 answers total)

Can you get a referral for an ENT?
posted by Young Kullervo at 5:16 PM on January 16, 2016 [3 favorites]

In your situation, I would ask your doctor for a referral to an ENT. They should be able to order imaging studies to see what's actually going on, and they will hopefully have better suggestions. (For reference, my doctor won't go past two rounds of antibiotics before sending me to ENT.)

While you wait for the referral to go through, I would also suggest drinking a LOT of water (way more than you think you need) and also using a NeilMed rinse bottle or Neti pot (which will do a better job of moistening/cleaning out your sinuses than the spray bottle). If your home is dry, adding a humidifier of some sort may help.

You may also be able to use decongestants, but I'll let other people make suggestions on those, as I personally can't take most of them.
posted by pie ninja at 5:18 PM on January 16, 2016

Hi! Welcome to my life!* 3 things could be going on here:

1. You're inadvertently eating something that's negating your antibiotics and that's not allowing the treatment to fully do its job.
2. AZ isn't enough and you need a more hardcore antibiotic.
3. You have lots of inflammation and irritation but no infection and your body is still producing yellow mucus because it's trying to clear itself out.

It's a bummer that you're allergic to the -cillins because Augmentin (amoxicillin and clavulanate) really, really kicks ass at addressing sinus infections IME. I would seek out an ENT and have them do a full inspection of your sinuses to see what's what. From there they can decide if there's a better antibiotic to try or if you need to take some allergy meds to reduce the inflammation and irritation which can sometimes mimic a prolonged sinus infection and/or lead to an additional infection if not reduced.

*I had 4 sinus infections last year and 3 the year before that. I am sending you much love and good thoughts because I understand how annoying it is to have a back to back infection that just doesn't go away. Hope you get better soon.
posted by Hermione Granger at 5:24 PM on January 16, 2016

Last time I had a sinus infection, I got put on a round of prednisone with antibiotics (after the first round of just antibiotics didn't work). I also used a spray and netti pot (Netti pot to get the gross stuff out, then spray). I was prescribed the prednisone taper at an ENT clinic (worked there), they tended to escalate quickly when the first round doesn't get rid of antibiotics doesn't work. Are you seeing your PCP or a specialist? I'd ask for a referral to a specialist (ENT), as suggested above.

Stay hydrated and get rest. It took about 1.5 months to really get rid of my last one, I think in part because I couldn't actually take time off to rest and recuperate (it was the busiest time of the year for me work-wise).
posted by ghost phoneme at 5:28 PM on January 16, 2016

Response by poster: 1. You're inadvertently eating something that's negating your antibiotics and that's not allowing the treatment to fully do its job.

What exactly could that thing be, that I might be eating to negate the antibiotics?
posted by hippybear at 5:51 PM on January 16, 2016

Another vote for prednisone + different antibiotic. Doxycycline worked well for me earlier this year on a bad sinus infection (I'm also allergic to penicillin.)
posted by dayintoday at 5:56 PM on January 16, 2016

Acidic foods such as citrus juice, carbonated beverages, chocolate, antacids and tomato-based products such as ketchup can all interfere with drug absorption.
posted by Riverine at 6:05 PM on January 16, 2016 [2 favorites]

I used to have horrible sinus infections and also had to have the prednisone + horse pill antibiotic to get rid of it. In my case, undiagnosed food allergies were causing the underlying inflammation.

If you did three rounds of the same antibiotic and the infection keeps coming back, it's likely that you've selected for an antibiotic-resistant bacteria population that isn't responding to the antibiotic anymore. You'll have to try another class.
posted by zenzicube at 6:19 PM on January 16, 2016

Response by poster: I've been taking non-opioid pain killers (etodolac and now diclofenac) for an injury, and have been mostly eating cottage cheese and yogurt with the rare venture into real food because they have been killing my appetite. Haven't had anything on that list of foods from Riverine.
posted by hippybear at 6:25 PM on January 16, 2016

Sinus infections can also be viral or, more rarely, fungal in nature, in which case an antibiotic won't do shit. I'm not sure what they do for chronic viral sinusitis beyond steroids; if it's fungal you definitely will end up at the ENT with instruments up your nose and then antifungal meds. If it's viral you may just have to wait it out.

I'm sorry. Sinus infections are complete balls and, IMO, exhibit A against intelligent design. :P
posted by Eyebrows McGee at 6:40 PM on January 16, 2016 [1 favorite]

I would get a second opinion from an ear, nose and throat specialist. They can clear out your sinuses for you and give you better advice. I've plenty of sinus infections in my life and I was never given a saline nasal spray to take 10 times a day. That sounds weird to me. When I was a kid, I had my adenoids removed because of sinus issues -- not sure if that would help an adult. I also later had my tonsils removed as an adult. I later started taking prescription nasal sprays for rhinitis and I haven't had a sinus infection since.
posted by AppleTurnover at 6:40 PM on January 16, 2016

Get another opinion. Antibiotic treatment for chronic sinusitis isn't straightforward or necessarily the best option AFAIK. Maybe it is in your case, maybe not, but its absolutely time to talk to a specialist.
posted by Justinian at 6:55 PM on January 16, 2016

You should probably have a culture done to make sure what you have is actually a bacterial infection. It may be a strain of bacteria that doesn't respond well to azithromycin , it might also be fungal or viral. Whatever the case, a culture will let you know what it is and how best to treat it. You shouldn't need a referral to an ENT to get the culture done, and honestly, your doctor should have recommended a culture after the first round of pills didn't clear it up.
posted by ananci at 6:56 PM on January 16, 2016

you could have a fungal infection which is far more insidious and harder to cure than a bacterial infection. go see a different doctor and bring up the fact that your infection is not responding well to antibiotics. if it does turn out to be bacterial they should put you on different meds. also, buy your self a vaporizer/ humidifier regardless. winter air is dry and indoor heating makes it worse. nothing is worse for the sinus than dry air. i have a cheap (less than $30) Vick's Vaporub brand humidifier that i bought at Duane Reade and use it all winter and i rarely get sick in winter anymore. seriously warm moist air is a godsend and the humidifier instructions recommend adding a pinch of salt; i usually add around half a teaspoon and it pours out great clouds of soothing steam. i got my last sinus infection from using bad water in a Neti pot and i thought i would die from the pain. a friend gave me Oxycontin and it barely out a dent in the pain i was feeling but it helped a little til my antibiotics thankfully kicked in. i feel for you.
posted by Conrad-Casserole at 7:06 PM on January 16, 2016

Response by poster: I'm having basically zero pain or sinus pressure... just horrible rotting puss smells and a bad taste in the back of my throat and stuff coming out when I blow my nose that is obviously not normal mucous (the other nostril is fine).
posted by hippybear at 7:09 PM on January 16, 2016

See someone fast, my friends grandchild had an infection that crossed to his brain and had emergency surgery.
posted by irish01 at 7:17 PM on January 16, 2016

I've had the same recently except with sinus pressure as well. Multiple courses of antibiotics, nasal sprays etc. I saw an ENT about it (not in any official capacity, it was my FIL) nothing helped. Finally I was desperate and saw a traditional Chinese medicine doctor. He gave me acupuncture and a course of herbs. I kid you not, months of on and off again agonising sinus infection was gone in two days. I was gobsmacked. I still am.
posted by Jubey at 7:19 PM on January 16, 2016 [1 favorite]

Have you been doing a sinus rinse or just sinus spray? Sinus rinse (like the neilmed squeeze bottles) is great for clearing out all of the goo and letting air flow through however briefly. I'd do it at least four times a day for a week and see if that helps anything. If not, then definitely an ENT.
posted by melissasaurus at 7:26 PM on January 16, 2016 [1 favorite]

I have finally kicked the months-long sinus infection I got back in October, so I feel your pain. I am really surprised if your doctor gave you three rounds of the same antibiotic-- I have never, ever (in decades of annual sinus infections that won't die) had a doctor repeat an ineffective antibiotic, and it was my understanding that to do so was Very Bad for Making Resistant Bacteria (TM).

What usually (eventually) works for me:
- Sudafed
- antibiotics
- allergy meds like Claritin (I also have allergies, and they interact poorly with a sinus infection, sending me into an infinite spiral)
- NeilMed sinus rinse (lots)
- Flonase
- astelyn
- lots of different cough remedies, because I end up with a hacking cough that won't die, too
- lots and lots of healthy sleep, food, generally taking care of myself

So, yeah, based on my experience, I'd add Sudafed, Flonase, and astelyn to your routine, and a real sinus rinse instead of just a spray.

FWIW, when I went to an ENT, he did a CAT scan and told me I had a severely deviated septum, and that though he almost never recommended surgery, he would for me. (Then the next month a friend had the same surgery with very serious complications of the "never smell again" kind, and I decided I could deal with being sick a few months a year.)
posted by instamatic at 7:38 PM on January 16, 2016

Prednisone + Flonase stopped my sinus infection.
posted by prk60091 at 7:51 PM on January 16, 2016

This is why you need to talk to (another) medical professional. So far as I am aware taking prednisone with an active infection is a bad idea. Particularly if its a fungal infection.
posted by Justinian at 9:33 PM on January 16, 2016

"cottage cheese and yogurt"

All that dairy could be further congesting you as well.
posted by Jacqueline at 11:25 PM on January 16, 2016

Read the slip with your meds or call the pharmacy. Many antibiotics shouldn't be taken with milk/ dairy, anti acids or foods with lots of calcium. I would also see a specialist. (Haven't had a sinus infection but have done a fair share of antibiotics for various infections.)
posted by Crystalinne at 1:55 AM on January 17, 2016

All that dairy could be further congesting you as well.

No, this is a myth. There is no relationship between dairy consumption and mucus production. It is a classic case of psychosomatic symptomology.

Of course if dairy is contraindicated for a particular antibiotic, that's another thing entirely.

Nthing ENT. I went through a terrible experience with sinusitis that wound up needing surgery. Antibiotic penetration of the sinuses is weak, and many bacteria are antibiotic-resistant. You can get pockets of infection in places that are very hard to clear. You do not want to have FESS surgery if you can help it (ouch, it was awful) but as a last resort it can work wonders. I went from sinus misery most of my life to not having a single infection in 22 years after getting the surgery to widen the openings and remove bone. But yes, there are also fungal sinusitis cases where anti-bacterial antibiotics make things *much worse.*

Also, Neti pots are inherently unsanitary and tap water is dangerous to use for irrigation. If you want to seriously try irrigation (which helped me a lot back in the day) the device of choice is this thing (used with a Waterpik system, and distilled water). Back in my suffering days it helped me a lot.

There is a giant amount of quackery attached to sinusitis. You need a good ENT. And you also might need a dentist, as some cases of refractory sinusitis result from upper dental infections that need to be treated at the source (which is what happened to me, and it did not present as a typical case of sinusitis as a result of where the infection started).

But consuming dairy products has zero to do with anything.
posted by spitbull at 5:54 AM on January 17, 2016 [1 favorite]

If you were one of my kids telling me you're at the end of Round 3 and still have these symptoms, I'd suggest you see a specialist because at the least, they can give you better answers. I'm sorry for your pain, sinus stuff is the worst and you have my sympathies.

In NO order of efficacy and YMMV, these are things that have helped chronic sinus shit in my family:

* HOT WASH EVERYTHING that comes near your face because there may be some nasty dust mites that are making things worse. Buy new pillowcases, too.
* Look around your house for potential allergens and get a heavy duty air purifier--even if you are not an allergy-ridden person, sometimes stuff just flares up and makes everything worse so you can get a bit better, but never 100%
* Don't eat dairy. Coconut milk ice cream is a nice treat, though.
* Alternate warm and cold compresses on your sinuses.
* I've seen acupuncture unblock friends with this type of thing.
* hardcore Sudafed.
* Increase your fluid intake to at least 80 fl. oz. daily. You should have (almost) clear pee.
* If you can, get a really good opiod-level painkiller just so you can relax and let your body heal
* I can't remember the name of it, but there's a steroid spray that ENT people use; it's good stuff
*Neti-pot at least 4x daily to blast that crap out of your face
* If possible, get a juicer or somehow commit to blasting your body with non-sugary, non-dairy drinks like green juices, kale drinks, lots of homemade lemonade with apples as sweetener. Super-green drinks.
* Stop caffeine if you can.
* Start drinking tea with agave or honey like it's your job.
* Nap more and try to nap with your head a little elevated.
* A wee bit of exercise can feel good; even a short brisk walk can get snot moving.
* They make these little personal humidifiers that you put hot water in and hold to your face an inhale for a bit. Use one a few times daily to break stuff up or even hold your face over a bowl of cooling boiled water. A wee bit of eucalyptus if you can deal with it feels nice.
* If you can, take a few days off and just sleep and Netflix. Rest, rest, rest.

But I'd get to an ENT if possible; they can be really helpful.
posted by yes I said yes I will Yes at 6:04 AM on January 17, 2016

Again, dairy (and caffeine) have no relationship whatsoever to sinusitis or mucus production. That is not useful advice for someone with an active infection.

The spray you can't remember is called a "topical steroid" (Flonase is the best known brand), not to be confused with systemic steroids like prednisone, which is a sledgehammer approach. Used intranasally it reduces swelling and inflammation of mucus membranes but does not fight the infection or reduce mucus production. And steroids (whether topical or systemic) do have serious side effects and what is known as "rebound" effects, meaning when you go off them the problem sometimes comes back worse. For an infection, a topical steroid may be indicated, but it is not a treatment of the cause of the problem. (For allergic rhinitis/sinusitis, it may be sufficient.)

One can assume the OP is beyond needing home-care tips that are mostly disproven folk remedies if s/he has already seen a doctor, been on antibiotics, and is not seeing the symptoms clear. What you need is a better doctor and some lab tests, maybe a CT scan, and an aggressive approach to treating the infection if it is a bacterial one (at this point, it probably is not viral -- many cases of bacterial sinusitis are *caused* by an initial viral infection but then become bacterial as mucus won't flow properly, the virus clears and you've still got sinusitis).

I wouldn't care so much except I went through a terrible experience with sinusitis that I treated too lightly initially before finding a good ENT who did a CT scan and cultures and quite possibly saved my life with surgery and almost a *full year* (on either side of the surgery, which was extensive) of broad spectrum antibiotic treatment -- or at least he prevented something much worse. Over time, untreated sinusitis can lead to other serious problems, up to and including sepsis.

Caffeine is actually probably *helpful* for a sinusitis patient, in fact. It is a vaso-dilator and increasing blood flow to the affected areas is a key to antibiotic penetration. Not to mention any hot liquid will help with symptoms because steam.

An ENT is also likely to prescribe a pharmaceutical decongestant (guaifenesin or pseudoephedrine). Decongestants are very important to treating refractory sinusitis, in fact. Again, they allow mucus to flow, reduce inflammation, and improve the penetration of antibiotics (and/or topical steroids).

PS: The one folk remedy I tried that really helped with my symptoms (including as I recovered from surgery) was Japanese Wasabi paste. I carried a tube around everywhere and would literally just eat a little bit every once in a while straight up. The head-clearing blast was miraculous.
posted by spitbull at 6:59 AM on January 17, 2016 [2 favorites]

Remembered the name, Azelastine, it's an antihistamine, not a topical steroid.

One can assume the OP is beyond needing home-care tips that are mostly disproven folk remedies if s/he has already seen a doctor, been on antibiotics, and is not seeing the symptoms clear.

The OP asked for other home treatments.
posted by yes I said yes I will Yes at 7:13 AM on January 17, 2016

Hopping back in to second spitbull's recommendation to see a dentist.
posted by yes I said yes I will Yes at 7:37 AM on January 17, 2016

The extremely frequent nose blowing may be a part of the problem. You may be blowing it all into the back of your sinuses, compacting it. Try to blow less frequently and more lightly, rapidly alternating nostrils.

I'm assuming other replies have recommended netti pot. If not give it a try, but be careful about getting the salt balance right (or you'll compound the irritation).

For any nastily lingering illness/infection, I find that really extreme amounts of sleep is the best way to break the cycle.

Looking long-term, I had perennial sinus problems until I started a daily meditation practice. I don't know anyone who meditates who has sinus issues. Can't quite explain it, but the relaxation/dilation that occurs with deep meditation may be part of it. Sinus problems seem to stem from a sort of stressed contraction in that area (you may be able to intuit this). Anyway…meditation is great for all sorts of other things, too.
posted by Quisp Lover at 8:12 AM on January 17, 2016

Azelastine and other topical antihistamines are designed to combat allergic inflammation (allergic rhinitis). They also have very little role in treating infectious sinusitis, unless the bacterial infection is secondary to an allergic inflammation.

Home remedies are awesome when you don't have a serious infection that is refractory to antibiotics, and when they are based in some scientific reality about the causes of the problem. Dairy and caffeine have no known relationship to sinusitis.
posted by spitbull at 8:13 AM on January 17, 2016

In my hometown there is an artificial "salt cave" to simulate seaside air. This works wonders on my sinuses, because it is sometimes trigured by pollution.
posted by thegirlwiththehat at 8:15 AM on January 17, 2016

Just saw Spitbulls reply. I'd assumed you'd already had careful MD care and ruled out more serious possibilities. If, so, I'd proceed per my suggestions. If not, I'd book appointments ASAP.
posted by Quisp Lover at 8:16 AM on January 17, 2016

Neti Pot three times daily. I find that the squeeze bottle type works very well. For a first time user there are prepackaged salt mixes to make it easy. I personally prefer Baraka's grey sea salt for mine. Good luck. I agree with the others though that you need to see an ENT.
posted by OkTwigs at 8:53 AM on January 17, 2016

What stands out to me here is the "rotting smell" which could be a sign of something serious. Definitely another doctor - a specialist, or if that's not possible, at least a different doctor. And the dentist suggestion is a good one.
posted by mai at 9:56 AM on January 17, 2016

Oh hey, I have had this since October too. Went to an ENT 2 days ago. He said the antibiotics I'd had were little better than placebos. That would have been Augmentin and a Z-pack. I'm now on 3 weeks of Cipro + prednisone. Go to an ENT.
posted by Kitty Stardust at 11:58 AM on January 17, 2016

It's ENT time.

I had a sinus infection for three years until I finally got it cleared up with an experimental protocol that involved putting steroids and antibiotics (budesonide and mupirocin) in a nasal lavage device and irrigating my sinuses with it twice a day. The idea behind this protocol is that many treatment resistant sinus infections are caused by a biofilm that coats the inside of your sinuses but isn't actually resident in your body, so systemic antibiotics never make it to totally solve the problem.

However, your mention of a "rotting smell" makes me wonder about something weirder and rarer. I had a good friend who had symptoms similar to yours for the better part of a year, and when she finally got a CT scan of her sinuses, they found a foreign body up there. It turned out she had food poisoning about three weeks before the infection started, and had vomited so strenously that it came out her nose. . . only not all of it came out. (Ick.) After she got that removed, the infection cleared up almost instantly.

Regardless, you need an ENT and probably a CT scan. In the meantime, get a neti pot or equivalent (I use the NeilMed squeeze bottle) and start doing nasal lavage twice a day, right before you go to bed and right after you get up. Sometimes I'll throw in a third in the middle of the day and make it a hypertonic rinse, where I use two of the little salt packets instead of one. It's really amazing how much improvement you can get just from doing that.
posted by KathrynT at 12:00 PM on January 17, 2016 [1 favorite]

Azithromycin is most effective when consumed with something acidic, like orange juice. If you take it with antacids or eat foods that contain bicarb with it, you will make it less effective. I have heard it competes with magnesium, so magnesium supplements and magnesium rich foods should be avoided for something like 2-4 hours both before and after.

When I had chronic sinus issues, I altered the doctor prescribed saline rinse recipe by substituting xylitol for a portion of the salt. It was both gentler and more effective. Make sure you get ALL surfaces of all sinuses. I used a bulb syringe or similar to administer a small amount of fluid and I would get in weird poses, like Muslim-style prayer (head to floor) pose, to get all the nooks and crannies, including the sinuses up above the eyes.
posted by Michele in California at 1:13 PM on January 17, 2016

Frankly I think azithromycin is puny. Granted my anecdata is limited, but it's what I've noticed over the years as a patient and observing any of my friends who have been put on it. Sometimes you have to get out the bigger guns, especially in a case like yours.

Similar to what Kathryn said, I have had some pretty good luck of late using a spray made in a compounding pharmacy, prescribed by my ENT, which is a combo of topical antibiotic/antifungal/AND steroid! It's pricey because it's custom made for them, but works pretty good, and has made it so I can typically avoid taking another systemic antibiotic when I'm hit with the occasional sinus infection. YMMV. If your sinus stuff has spread deeper in there at this point, you may definitely need a regular oral antibiotic.

Find a good ENT! : )
posted by bitterkitten at 8:03 PM on January 22, 2016