Doc: Most cases of sinusitis don’t require antibiotics
Dear Dr. Roach: Every year and a half to two years, someone in our house gets a sinus infection. We are in our mid-60s, and it is always a fight with our doctor to get antibiotics to cure it. We go through at least two weeks of misery with nasal sprays, Tylenol, etc., before he finally decides that it is bacterial and prescribes the antibiotics. I understand that the use of antibiotics has gotten out of control, but I believe that antibiotics sometimes are needed. Should we have to fight this hard to feel well when we take antibiotics infrequently?
Dear J.K.L.: You’re not going to like my answer, but I agree with your doctor.
Most cases of acute (less than four weeks of symptoms) sinusitis are caused by viruses. Up to 70 percent of common colds will show sinusitis on a CT scan, but less than 2 percent of symptomatic sinus infections are thought to be caused by bacteria — even many of those will get better without antibiotics.
You certainly are right that sometimes the infection is bacterial and antibiotics are needed, but people can be spared the risks of antibiotics (many of which I have recently discussed, including C. difficile diarrheal infections) by just waiting long enough for the symptoms to get better on their own. Symptomatic treatments — such as saline irrigation, steroid nasal sprays, a few days’ worth of decongestants and, yes, Tylenol — can relieve the misery.
Resistance to antibiotics is becoming a critical issue. I have seen patients die of bacterial infections because we have literally no effective antibiotics with which to treat them. For our own patients’ safety and for public health reasons, we physicians need to prescribe less. I hope you understand why your doctor is being extra cautious about prescribing antibiotics.
Dear Dr. Roach: Can you tell me the benefits and risks of Namzaric? Who should take it? What is it taken for?
Dear C.J.H.: Namzaric is a brand name of a combination of two medications for Alzheimer’s. Memantidine (also sold as Namenda) and donepazil (Aricept) are used separately for people with moderate to severe dementia. Although these medicines do not stop the underlying cause of dementia, they can slow, stop and sometimes reverse dementia symptoms for a time. Both memantidine and donepezil are modestly effective: The combination of the two seems to have better results and may be easier to take, as it’s just one pill.
Side effects can include slow heart rate and stomach upset or diarrhea. There are other serious but rare side effects, so this medication should be given only when it is likely to be of benefit. (I usually don’t give these medications to people with only mild memory loss.)
Dear Dr. Roach: I was treated for tinnitus with bioflavonoids. Within a few days, I noticed a definite improvement. My tinnitus is much better, and now I get symptoms only when I am very tired. I hope this story helps someone.
Dear J.F.B.: Bioflavonoids are a class of compounds found in many natural products, especially in the rinds of citrus fruits. They are reported to have many benefits, including potential improvements in blood pressure and cholesterol. Some studies have shown improvement in tinnitus with bioflavonoid supplements, but the most recent and largest studies have not shown any help. However, they are generally safe, and a trial of taking bioflavonoids (either as a supplement or just through increased fresh fruit) is reasonable. There may be a placebo effect, but I also hope someone gets helped by your suggestion, regardless of whether it’s a placebo response.
Email questions to ToYourGoodHealth@med.cornell.edu.