What can I do to get relief from a sinus infection without antibiotics?

DEAR DOCTOR K:

My doctor won’t give me an antibiotic for my sinus infection. So what can I do to feel better?

DEAR READER:

Most cases of sinusitis are caused by viral infections. Viruses are bulletproof to antibiotics. All antibiotics can do in this case is cause side effects. So, the best course of action for occasional sinusitis is to use self-care steps to ease symptoms while the body clears the infection.

Your sinuses are hollow spaces in your facial bones. In response to infection, the sensitive lining of the sinuses swells up and starts to pour out mucus, triggering nasal stuffiness, a runny nose and facial pain. You might also experience fatigue, cough, impaired sense of smell, fullness or pressure in the ears, or headache.

While your body fights the infection, these self-care steps can help to ease symptoms:

SPRAY IN SOME SALINE. Saline (saltwater) rinses are very soothing. Frequent, gentle snorts of a prepackaged saline spray can help to loosen mucus.

USE DECONGESTANTS. Over-the-counter decongestant pills or nasal sprays can be used on a limited basis to reduce stuffiness.

  • Nasal spray decongestants: Limit yourself to no more than two doses per nostril per day for no longer than five days. If you use a nasal decongestant for too long, you can get the opposite effect from what you seek: Your nose may start running when you stop using the decongestant.
  • Decongestant pills: A common side effect of these pills is moderate jitteriness. You shouldn’t take such pills if you have uncontrolled high blood pressure or a heart condition.

TAKE A PAIN RELIEVER TO EASE HEADACHE OR FACIAL PAIN. For inflammation, you may get more benefit from a nonsteroidal anti-inflammatory drug like ibuprofen (Advil, Motrin), naproxen (Aleve) or aspirin.

So when might it be reasonable to ask your doctor to prescribe antibiotics for a sinus infection, because it might be caused by bacteria? Here are some rules of the road:

  • When the symptoms are prolonged. For example, if after 10 days your infection is not getting better, it’s reasonable to call your doctor and ask about an antibiotic.
  • When the symptoms are severe. Alarm signs of a bacterial sinus infection are sharp pain in the cheeks or teeth accompanied by a fever.
  • When the symptoms are getting worse. If you have cold-like symptoms that progress to severe pain and fever, antibiotics may be worth considering.

Finally, even if your doctor does eventually prescribe an antibiotic, don’t expect too much. In clinical trials that compared antibiotics to a placebo pill for confirmed bacterial sinusitis, the antibiotic had minimal effect.

Why is that? Most likely it’s because the sinuses are blocked. A bacterial sinus infection needs to drain. It’s like a boil on your skin, if you’ve ever had one. Antibiotics help only a little — until the boil is lanced and the pus inside drains away. Also, the antibiotic in the bloodstream can’t reach the bacteria inside the sinus, just the bacteria in the lining of the sinus (which is where the blood is flowing).